Provider Audit and Reimbursement - Lead Auditor (CMS)

Job Description

Job Description

PROVIDER AUDIT AND REIMBURSEMENT LEAD AUDITOR (CMS) - REMOTE

ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Lead Auditor (CMS)! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential.

100% REMOTE!

Candidates must currently have PERMANENT US work authorization.

Job Description :

The Provider Audit and Reimbursement Lead 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, as well as interim rate review / reimbursement, and / or 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 and oversee daily workload of unit team.

ESSENTIAL DUTIES & RESPONSIBILITIES

Lead Accountabilities (60%) :

• Coordinates with management by overseeing the unit's daily workload. Routinely uses independent judgment and discretion to make decisions for self and less experienced auditors with regard to additional time and procedures; identifies and raises errors to the attention of supervisor and / or provider and identifies and communicates actions to correct same. Prioritizes auditor work and ensures that audit work is completed on time. Recognizes data needs for self and other auditors; develops plan of work for less experienced auditors (10%)
• Analyzes working papers and cost reports for errors. (10%)
• Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (10%)
• Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal and State Government regulations for each class / type of provider within area of responsibility. (5%)
• Develops technical competence and constructive work attitudes in self and less experienced auditors; strives to build an effective team and to develop the growth needs of individual members of his / her team. (10%)
• Coordinates the assignments and subsequent development of auditors based on their training needs; explains work to be performed and principle or objective of procedure; provides accurate and constructive coaching, mentoring, and training of team members. Identifies training needs within the team and / or department. (5%)
• Manages, implements and coordinates an internal quality control program in conjunction with the Internal Quality Control (IQC) department and provides reasonable assurance that the Provider Audit and Reimbursement Department has established, as well as is following, adequate policies, procedures, and is following applicable auditing standards. (5%)
• Facilitates the development of Quality Management System (QMS) policies and procedures. (5%)

Auditor Accountabilities (40%)

REQUIRED QUALIFICATIONS

To demonstrate the necessary experience, the candidate must have performed the following tasks at a sufficiently successful level to show understanding of the work, judgment, and the ability to perform these tasks independent of supervision, which is generally gained through 2.5 to 3 years of Medicare cost report auditing experience :

Additionally :

PREFERRED QUALIFICATIONS

3 to 4 years of Medicare cost report auditing experience

Demonstrated work experience to independently perform :

Requirements

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.

Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke johnb@arcgonline.com or apply online while viewing all of our open positions at www.arcgonline.com.

ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.

At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.

Position is offered with no fee to candidate.