PARD Sr Auditor - Novitas Solutions

Overview

This role utilizes 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 Medicare cost reports. Responsibilities also include interim rate review/reimbursement and settlement acceptance/finalization for all provider types, including complex and organ transplant hospitals. The position serves as both a preparer and reviewer of work product based on established performance goals and includes mentoring and training of Auditors and In-Charge Auditors.

Responsibilities

Audit Accountabilities (65%)

• Analyzes Medicare cost reports and computes complex rate reviews on large and medium size facilities to support accurate interim payments. (10%)
• Analyzes Medicare cost reports and completes calculations of cost-to-charge ratios (CCRs) and provider payment information, ensuring accuracy. (10%)
• Compares prior year to current year cost report results, completes desk review, coordinates with the Lead on field audits, and is in charge of field audits for small, medium and large sized providers and Medicare cost report appeals. (10%)
• Performs supervisory reviews of desk reviews completed by other audit staff by providing relevant review points that 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%)
• Builds constructive provider relationships by maintaining professionalism, demonstrating a positive corporate image, and assisting providers in 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%)
• Accounts for special projects related to complex payment methodologies, including research, project planning, staff training, and timely implementation of CMS requirements. (5%)

Development / Mentoring Accountabilities (30%)

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

Other (5%)

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

Requirements

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 of the position.
• Generally 2 years of Medicare cost report auditing experience, demonstrated through successful completion of the tasks below at a sufficiently successful level to show understanding of the work, judgment, and ability to perform independently with limited or no supervision:
  • 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 relevant testing according to CMS standards
  • A review of DSH, including relevant sample selection and relevant 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 achievement of understanding by the provider
• Demonstrated leadership skills through involvement in junior auditor formal training, assistance on special projects, or 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.
• Ability to demonstrate engagement, commitment to departmental success, and professionalism by:
  • Completing work within prescribed deadlines
  • Taking ownership of work
  • Setting an example for more junior auditors and staff by consistently and reliably working the time necessary to properly complete duties
  • Timely attending meetings
  • Providing adequate notice to management and co-workers when unexpected issues arise
  • Ensuring work is properly covered in 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 reviews including:
  • Nursing & Allied Health Education (NAHE), including calculating the additional add-on payment and all relevant testing
  • Organ Acquisition costs, including all relevant testing
• MBA, CPA

Compensation & Benefits

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 Requirements (Federal / CMS Access)

• Federal Government and 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, you must undergo a pre-employment Background Investigation and Drug Screen. Identity proofing documentation must be cleared prior to hire.
• Most positions are subject to additional identity proofing, fingerprinting, and additional background investigation screening conducted by the Federal Government for Enterprise User Administration (EUA) system logical access after employment begins.
• Continued employment is contingent upon the outcome of the complete additional screening criteria required for the position, including meeting government customer requirements (e.g., suitable for access to CMS information and information systems), and any additional investigation that may be required throughout employment. If not suitable, employment may be subject to corrective action, up to and including immediate termination.
• Identity documentation requirement: 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.