Provider Auditor

Provider Auditor I

The Provider Auditor is responsible for conducting Centers for Medicare & Medicaid Services (CMS) and other financial analysis, limited and full desk reviews, and in‑house and on‑site field audits to ensure proper reimbursement for health care providers for the Medicare programs. These positions are the face of Noridian interacting with providers/facilities management through the audit process which requires an advanced level of professionalism.

Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plans, and prepares/submits reports on the results of audits.

• Initiates, plans, conducts, and finalizes audits of financial, management, and administrative procedures of assigned cost reports. Responsible for determining appropriate scope and procedures for each individual review. Analyzes audit program to determine proper procedures are performed based on scope.
• Provides independent judgment and decisions regarding reviews and minimizes risk for organization and quality control.
• Participates in and facilitates meetings, entrance conferences, walkthroughs, and exit conferences with external providers.
• Develops knowledge of documentation requirements from audit testing through preparation of audit work papers.
• Possesses excellent written and verbal communication skills needed to draft, deliver, and issue corrective action plans for audit adjustment reports to consultants, CPA firms, management and provider executives.
• Performs risk analysis on provider financial statements to determine impact of potential risk of Medicare dollars.
• Must obtain a minimum of 80 CET hours every two years.
• Provides proactive support and process improvement by participating in special projects, documenting work as prescribed by the project, collaborating with internal and external customers to determine and distribute requested information and documentation.

• Other duties as assigned

• Bachelor's degree in Accounting, Business, Finance or equivalent work experience
• Knowledge of accounting theory and practices
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint)

• Bachelor's degree in Accounting, Business or Finance
• Excellent written and verbal communication skills
• Excellent organizational skills

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to:
Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company‑paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian prime…