PARD Sr Auditor - First Coast

Overview

This role uses advanced knowledge of Medicare laws, regulations, instructions from the Centers for Medicare and Medicaid Services (CMS), and provider policies to perform desk reviews and audits of annual Medicare cost reports, interim rate review/reimbursement, and settlement acceptance/finalization for all provider types, including complex and organ transplant hospitals. The position supports both preparation and review of work products based on established performance goals and mentors/trains Auditors and In-Charge Auditors.

Responsibilities

Audit Accountabilities (65%)

• Analyzes the cost report and computes complex rate reviews on large and medium-sized facilities for accurate interim payments. (10%)
• Analyzes the cost report and completes calculations of cost-to-charge ratios (CCRs) and provider payment information to ensure accuracy. (10%)
• Analyzes the cost report by comparing the prior year to the current year, completing desk review work, coordinating with the Lead on field audits, and serving as in-charge for field audits of small, medium, and large providers and Medicare cost report appeals. (10%)
• Performs supervisory reviews of desk reviews completed by other audit staff, providing relevant review points to support coaching, mentoring, and training of less tenured staff. Ensures provider desk reviews, cost report appeals, and field audits are completed in accordance with CMS regulations and Government Auditing Standards. (10%)
• Establishes and maintains constructive provider relations through a professional approach, a positive corporate image, and support in provider problem areas; advises healthcare providers on Medicare policy questions. (10%)
• Establishes audit and desk review timeliness and scheduling to ensure compliance with CMS metrics and internal production goals. (10%)
• Supports special projects related to complex payment methodologies, including research, project planning, training of staff, and timely implementation of CMS requirements. (5%)

Development/Mentoring Accountabilities (30%)

• Assigns and develops auditors based on their training needs; explains assigned work and the principle/objective of procedures; provides accurate, constructive feedback; determines future training needs. Identifies training needs within the team and department and provides training on reimbursement principles and the process of completing simple to complicated rate reviews, including reviewing simple to complex rates at the first review level. (10%)
• Serves as a mentor in the department. (10%)
• Ensures development of quality work products that meet or exceed CMS expectations. (10%)

Other (5%)

• Attends entrance and exit conferences and advises healthcare providers on Medicare policy questions as needed, including completing the required number of hours of Continuing Education Training (CET). (5%)

Required Qualifications

• Bachelor’s 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, plus required work experience to independently perform the duties
• Demonstrated experience gained through 2 years of Medicare cost report auditing experience, with tasks performed at a sufficiently successful level to demonstrate understanding, judgment, and the ability to perform independently with minimal/no supervision

Experience requirements (independently performed)

• 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 relevant sample selection and testing according to CMS standards
• A review of DSH, including 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
• Review and appropriate approval of an audit’s scope
• A supervisory review of certain provider types (may vary by team)
• Sample testing, transferring of testing to the audit adjustment report, and explaining adjustments to a provider with the achievement of understanding

Additional required capabilities

• Demonstrated leadership by involvement in junior auditor formal training or special projects, or prior experience as a Subject Matter Expert (SME)
• 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
• Demonstrated engagement, commitment to departmental success, and professionalism by completing work within prescribed deadlines; taking ownership of work; setting an example by consistently and reliably working the time necessary to properly complete duties; timely attendance at meetings; providing adequate notice to management and coworkers when unexpected issues arise; and ensuring work is properly covered during the auditor’s absence
• Demonstrated oral and written communication skills
• Demonstrated ability to exercise independent judgment and discretion
• Demonstrated attention to detail

Preferred Qualifications

• 2 to 3 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
• MBA, CPA

Compensation & Benefits

• 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.

Additional Eligibility & Screening Requirements

• The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed. These years of residence do not have to be consecutive.
• If selected, a pre-employment Background Investigation and Drug Screen are required, and identity proofing documentation must be cleared prior to hire.
• Most positions are subject to additional identity proofing, fingerprinting, and additional background investigation screening by the Federal Government for Enterprise User Administration (EUA) system logical access after employment begins.
• Continued employment is contingent upon outcomes of required additional screening criteria that confirm suitability for access to CMS information and information systems, and any additional investigation required throughout employment. If found not suitable, employment may be subject to corrective action, up to and including immediate termination.
• Identity documentation required: access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Employment Authorization Cards (EAD) are not a substitute for visas or U.S. Permanent Resident Cards.

Equal Opportunity Statement

Equal Opportunity/Protected Veteran/Disabled Employer.