Senior Auditor

Senior Auditor

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians. This position is located in Reimbursements, Richland County. This is an in-office role and not a telecommute or remote position. Are you the One? We are looking for a Senior Auditor who will perform daily operations and activities surrounding SC Medicaid inpatient and outpatient hospital reimbursement as well as SC Medicaid Disproportionate Share Hospital payment activities to ensure compliance with the Centers for Medicare and Medicaid Services Regulations and the SC Medicaid State Plan.

Responsibilities include:

• Checks master DSH calculation worksheet file to ensure that all data elements transferred accurately. Validates that DSH surveys are completed/acceptable and that balances reconcile back to the uninsured and Medicaid MCO worksheet files submitted and if noted reconciles any differences that may occur. Calculates the Medicaid Day Utilization Rates and the Low-Income Utilization Rates for all SC Medicaid DSH eligible hospitals.
  
  Verifies that each qualifying DSH hospital has a Medicaid Utilization Rate in excess of 1%. Validates that qualifying DSH hospitals meet the federal OB requirement. Accumulates and reviews "as filed DSH data" selected for analysis based upon agency defined criteria for compliance with the December 19, 2008 Final Rule relating to the audits of the Medicaid DSH Program as well as the December 3, 2013 Final Rule related to the definition of the Uninsured for the Medicaid DSH Program.
  
  Validates Calculates and processes the annual DSH payment amounts. Prepares necessary and accurate correspondence related to quarterly DSH payments, including the hospital specific DSH worksheets when applicable.
• Calculates graduate medical education (GME) reimbursement for Medicaid managed care patients. Ensures accuracy and adequate, complete, and clear documentation. Prepares necessary and accurate correspondence related to these payments. Summarizes GME payments via incurred dates for each teaching hospital for DSH payment purposes.
• Calculates and reviews inpatient and outpatient hospital cost to charge ratios (Medicaid FFS and Medicare FFS) used for SC Medicaid fee for service and SC Medicaid DSH payment purposes. Reviews the calculation of provider generated Uninsured and Medicaid Managed Care cost to charge ratios for reasonableness.
• Prepares both debit and credit adjustments. Ensures accuracy and complete supporting documentation for adjustments.
• Calculates, reviews, and processes interim retrospective inpatient and outpatient hospital cost settlements for qualifying hospitals. Performs similar computations for non-qualifying SC hospitals as well. Ensures accuracy and complete and clear documentation. Generates worksheet files needed to determine the retrospective settlement for both qualifying and non-qualifying hospitals. Prepares necessary and accurate correspondence for only those hospitals eligible to receive retrospective cost settlements.
  
  Completes final retroactive settlements identified via final audit reports issued by the audit contractor (Myers and Stauffer). Prepares necessary and accurate correspondence related to these settlements.
• Performs other duties as assigned including any updates/creation of current/new SAS reports.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

Minimum and Additional Requirements include:

• A bachelor's degree and experience in accounting or finance and professional experience in accounting, auditing, finance, insurance or tax prep/analysis.
• Lifting requirements: 20 lbs.
• In-office Role

Preferred Qualifications include:

• A bachelor's degree in accounting or a course of study that included fifteen (15) hours in accounting related courses and (2) years of accounting and auditing experience. Knowledge of Medicare and/or Medicaid reimbursement principles. Experience in preparing Medicare and/or Medicaid cost reports.
• Ability to communicate effectively both orally and in writing.
• Ability to set priorities, establish time frames, and successfully complete tasks in a timely manner.
• Ability to think and work independently, to exercise judgment and discretion, to be flexible, adaptable and resourceful.
• Ability to interpret and apply laws, regulations, policies and procedures.
• Knowledge of the principles, theories, and practices of accounting, auditing, budgeting and financial management.
• Knowledge of Medicare and Medicaid reimbursement principles.
• Ability to communicate effectively.
• Ability to establish and maintain effective working relationships

Additional Comments include:

Please complete the State application to include all…