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Senior Provider Auditor - 300150

Employer
Noridian Healthcare Solutions
Location
Fargo
Salary
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* Department may consider telecommuting for this position *

Job Summary

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.

Key Performance Indicators
  • Meets CMS standards while maintaining departmental performance expectations
  • Excellent attention to detail
  • Ability to prioritize and multi-task workload


Essential Functions

Key Duties/Responsibilities/Accountabilities

FLSA Category: Exempt - Administrative
  • Develops a working knowledge of Medicare reimbursement principles and the Medicare Cost Report.
  • Participates in the planning, organizing, and coordinating of the desk review process.
  • Assists Provider Auditor II & Senior Provider Auditor with in-house and on-site field audits.
  • Assists Provider Auditor II & Senior Provider Auditor in calculating limits and exceptions and completing wage index desk reviews.
  • Develops and maintains a positive working relationship with providers.
  • Possesses an intermediate level of working knowledge of Medicare reimbursement principles and the Medicare Cost Report.
  • Identifies areas of opportunity and provides solutions for efficiency and process improvement.
  • Provides support and input for specialized and in-depth projects with increased complexity.
  • Handles cost report re-openings and appeals.
  • May lead basic in-house and on-site field audits.
  • Possesses and maintains a high level of working knowledge in Medicare reimbursement principles and the Medicare Cost Report.
  • Participates in in-house and on-site field audits.
  • Provides strategic insight and guidance to Provider Auditors using their knowledge, experience, and research.
  • Performs reviews on Auditor I & II work and corrects errors and omissions by departmental staff.
  • Provides independent judgement and decisions regarding reviews and minimizes risk for the organization by providing quality control.
  • Enhances and maintains strong, professional working relationships with providers.
  • May lead smaller projects.
  • May conduct reviews for smaller engagements.
  • May serve as team lead to ensure projects completed on time, on scope, and on budget.


Non-Essential Duties and Functions
  • Other duties as assigned

Requirements

Qualifications

Minimum Qualifications:
  • 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)
  • Demonstrated knowledge of Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software)
  • 3-years' Medicare auditing experience
  • Advanced knowledge of Medicare reimbursement principles and regulations and Medicare Cost Report

Preferred Qualifications:
  • Bachelor's degree in Accounting, Business or Finance.
  • Excellent written and verbal communication skills
  • Excellent organizational skills
  • Ability to coach, advise, and develop others
  • Demonstrated understanding of industry and enterprise objectives
  • Excellent presentation skills

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


Segregation of Duties

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.

Statement of Other Duties

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 by management.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency-specific regulations and related clauses included in NHS's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Other Information

Job Posting Policy 6.05

New employees with Noridian Healthcare Solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@noridian.com.

This job posting will be closed 09/28/2018 at 8:00AM CST. No further applications will be considered.



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