PARD Sr Auditor - First Coast - Remote, FL

United States of America-USAUS

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.

• 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

The Provider Audit and Reimbursement Senior Auditor 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 the annual Medicare cost reports, interim rate review/reimbursement, and settlement acceptance/finalization for all provider types including complex and organ transplant hospitals, as both a preparer and reviewer of work product based on established performance goals.

The position will mentor and train Auditors and In-Charge Auditors.

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 the cost report and computes complex rate reviews on large and medium size facilities for accurate intern payments. (10%)
• Analyzes the cost report and completes the calculation of cost-to-charge ratios (CCRs) and provider payment information, ensuring accuracy. (10%)
• Analyzes the cost report by comparing the prior year to the current year and completing the desk review, coordinates with Lead on field audits and is in charge of field audits of small, medium and large sized providers and Medicare cost report appeals. (10%)
• Performs supervisory reviews of desk reviews performed by other members of the audit staff by providing relevant review points that facilitate the coaching, mentoring, and training of less tenured staff. Ensures that provider desk reviews, cost report appeals and field audits are completed in accordance with CMS regulations and Government Auditing Standards. (10%)
• Establishes or maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image and assisting provider in problem areas. Advises healthcare providers on Medicare policy questions. (10%)
• Establishes the timeliness and scheduling of audits and desk reviews to ensure compliance with requirements for CMS metrics and internal production goals. (10%)
• Accountable for special projects relating to complex payment methodologies. This involves research, project planning, training of staff and timely implementation of CMS requirements. (5%)

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

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

Performs other duties as the supervisor may, from time to time, deem necessary.

• Bachelors' degree or a combination of education and experience in disciplines such as auditing, accounting, analytics,…