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%) Performs audit functions including those which are non-routine; keeps track of instructions for many projects simultaneously. Presents and defends adjustments and workpapers to provider with minimal consultation from manager. (10%) Coordinates large audits and/ or diverse audits independently while seeking help on truly unusual or major items. (10%) Uses professional communication techniques in own and auditor's work and in conclusions drawn from the work. (5%) Establishes and maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image. Advises providers on Medicare policy questions and directs other questions to responsible departments or personnel. (5%) Conducts entrance and exit conferences and meetings away from office as needed. (5%) Perform other duties as the manager 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 In addition to having a thorough understandi