Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.

Benefits info:

* 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

SUMMARY STATEMENT

The Provider Audit and Reimbursement Auditor (PARD) position can fill two primary roles -- desk review/audit, and interim rate review. Incumbents analyze cost reports and provider statistical and reimbursement report information to determine accurate and timely tentative settlements of bad debt payments or other pass-through costs; perform limited and full desk reviews of cost reports for providers that receive Medicare reimbursement and assist senior staff who perform hospital audits.

ESSENTIAL DUTIES & RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
* Analyzes cost report and provider statistical and reimbursement report (PS&R) information to determine accurate and timely Skilled Nursing Facility (SNF), End Stage Renal Disease (ESRD) and Federally Qualified Health Centers (FQHC)/Rural Health Clinics (RHC) tentative settlements of bad debt payments or other pass-through costs. Analyzes the cost report and accompanying bad debt logs to update pass-through payment amounts and determine lump-sum adjustments for interim rate accuracy. (30%)

* Performs limited and full desk reviews of cost reports for SNFs, ESRDs, FQHCs/RHCs providers and hospitals that receive Medicare reimbursement. Generates and customizes all required internal and external correspondence and checklists to facilitate implementation and evidence of the completion of the desk reviews. (30%)

* Coordinates with the Senior and/or In-Charge auditor in performing hospital audits. Performs post audit activities including follow-up with provider representatives and preparing the final cost report package. (15%)

* May be responsible for a number of special projects that could include duplicate interns and residents (IRIS) data, transmission of cost report information (HCRIS), wage index submissions, system for tracking audit and reimbursement (STAR) updates including the tracking of providers, cost reports and continuing education and training (CET), HFS cost report software, SNF pass through logs, and PS&R backup. (10%)

* Assists management in the administrative functions of the department including creating and maintaining electronic and hard copy provider cost report files, participating in continuous improvement projects, etc. (5%)

* Attends entrance and exit conferences and advises healthcare providers on Medicare policy questions as needed. (5%)

* Performs other duties as the supervisor may deem necessary (5%)

REQUIRED QUALIFICATIONS

* 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

* Demonstrated oral, written and interpersonal communications skills

* Computer skills including knowledge of Microsoft office suite, Excel, Word, Outlook and PowerPoint

PREFERRED QUALIFICATIONS

* N/A

Qualifications

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 with the Company. These years of residence do not have to be consecutive.

Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and 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 to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment.

Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.

"We are an Equal Opportunity/Protected Veteran/Disabled Employer."

This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, 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.

PARD Auditor - Novitas

Key skills

About this role