PARD Lead Auditor - Novitas

Overview

The Provider Audit and Reimbursement Lead uses advanced knowledge of Medicare laws, regulations, Centers for Medicare and Medicaid Services (CMS) instructions, and provider policies to perform desk reviews and audits of annual Medicare cost reports. This role also supports interim rate review/reimbursement and/or settlement acceptance/finalization for provider types, including complex and organ transplant hospitals. Responsibilities include both preparing and reviewing work product against established performance goals, while mentoring and training Auditors and In-Charge Auditors and overseeing daily unit workload.

Responsibilities

Lead Accountabilities (60%)

• Coordinate with management by overseeing the unit’s daily workload.
• Use independent judgment and discretion to make decisions for self and less experienced auditors regarding additional time and procedures.
• Identify, raise, and communicate errors to the attention of a supervisor and/or provider, including actions to correct them.
• Prioritize auditor work to ensure audit completion on time.
• Recognize data needs for self and other auditors; develop work plans for less experienced auditors (10%).
• Analyze working papers and cost reports for errors (10%).
• Review auditors’ workpapers for correctness, control, and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS), and Government Auditing Standards (GAS) as required.
• Ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction by reviewing workpapers upon completion.
• Ensure proper references, clear and concise conclusions for major audit categories, and assembly of working papers into logical sequence (10%).
• Review, evaluate, and approve disbursement of tentative cost settlements in compliance with Federal and State Government regulations for each class/type of provider within area of responsibility (5%).
• Develop technical competence and constructive work attitudes in self and less experienced auditors, supporting team effectiveness and individual growth (10%).
• Coordinate assignments and subsequent development of auditors based on training needs.
• Explain work to be performed and the principles/objectives of procedures.
• Provide accurate, constructive coaching, mentoring, and training (5%).
• Manage, implement, and coordinate an internal quality control program with the Internal Quality Control (IQC) department, providing reasonable assurance that adequate policies and procedures are established and followed and that applicable auditing standards are met (5%).
• Facilitate development of Quality Management System (QMS) policies and procedures (5%).

Auditor Accountabilities (40%)

• Perform audit functions, including non-routine items, while tracking instructions for multiple projects simultaneously (10%).
• Coordinate large and/or diverse audits independently while seeking help on unusual or major items (10%).
• Use professional communication techniques in work and in conclusions drawn from the work (5%).
• Establish and maintain constructive provider relations by demonstrating a professional approach and positive corporate image.
• Advise providers on Medicare policy questions and direct non-relevant questions to responsible departments or personnel (5%).
• Conduct entrance and exit conferences and meetings away from the office as needed (5%).
• Perform other duties as the manager may deem necessary (5%).

Requirements

• Bachelors’ degree, or a combination of education and experience in disciplines such as auditing, accounting, analytics, finance, or similar experience in lieu of a degree.
• Thorough understanding of the Medicare cost report, including the step-down method.
• Required work experience to independently perform the duties of the position.

To demonstrate the necessary experience, the candidate must have performed the following tasks at a sufficiently successful level to show understanding, judgment, and the ability to perform independently, generally gained through 2.5 to 3 years of Medicare cost report auditing experience:

• A Uniform Desk Review (UDR) and an audit for a large or complex hospital as the in-charge auditor
• A review of Medicare Bad Debts, including all relevant sample selection and testing according to CMS standards
• A review of DSH, including all relevant sample selection and testing according to CMS standards
• A review of IME/GME, including reviewing rotation schedules, bed count, and all relevant testing according to CMS standards
• A review and appropriate approval of an audit’s scope
• Supervisory review and approval of all work papers
• Sample testing, transferring of testing to the audit adjustment report, and explaining adjustments to a provider with demonstrated provider understanding
• Assistance to audit management in assignment and monitoring of workload, as well as leading junior team members

Additional requirements:

• Leadership skills, demonstrated through involvement in junior auditor formal training, assistance on special projects, or prior Subject Matter Expert (SME) experience
• Ability to prepare workpapers according to CMS standards
• Good working knowledge of all applicable software applications
• Ability to serve as an effective mentor for less experienced staff
• Engagement, commitment to departmental success, and professionalism, including meeting prescribed deadlines, taking ownership, and setting an example for more junior auditors through consistent, reliable completion of duties, timely meeting attendance, timely notice to management and coworkers when unexpected issues arise, and ensuring work is properly covered during absence
• Demonstrated oral and written communication skills
• Demonstrated ability to exercise independent judgment and discretion
• Demonstrated attention to detail

Preferred Qualifications

• 3 to 4 years of Medicare cost report auditing experience
• Demonstrated work experience to independently perform:
  • A review of Nursing & Allied Health Education (NAHE), including calculating the additional add-on payment and all relevant testing
  • A review of Organ Acquisition costs, including all relevant testing

Compensation & Benefits

Benefits offered include:

• Medical, dental, vision, life, and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

Location

Remote work is available in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA, in-office and hybrid work may also be available.