First Coast Service Options Looking for Remote Lead Provider Auditor at Remote Full Time

Job type full-time

Full job description

Are you an experienced medicare auditor looking to demonstrate your leadership skills and grow in your career? if so, consider joining us today!

Get to know us!

Guidewell and its family of forward-thinking companies are focused on helping people and communities achieve better health and are at the forefront in the transformation of health care.

First coast service options, a guidewell company, provides high-quality, innovative, administrative services for government-sponsored healthcare programs.

What we can offer you!

We offer competitive salaries and benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise!

In this role you would gain valuable leadership experience that will help you to continue to grow in your career!

What will be your purpose:
As the provider audit and reimbursement lead you will oversee, mentor, and train auditors and in-charge auditorsYou will be responsible for following medicare laws and instructions for medicare services (cms) to perform complex medicare cost report audits and desk reviewsYou may be asked to perform other duties as the manager may deem necessary.

To be successful you must demonstrate engagement, commitment to departmental success, and professionalism by completing their work within prescribed deadlinesAs a leader you will take ownership of junior auditors and staff and set an example to complete their duties consistently and reliably.

What will you be doing:

Lead responsibilities

Coordinates with management by overseeing the unit’s daily workloadRoutinely 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 samePrioritizes auditor work and ensures that audit work is completed on timeRecognizes data needs for self and other auditors; develops plan of work for less experienced auditors.
Analyzes working papers and cost reports for errors.
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 requiredExamines 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.
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.
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.
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 membersIdentifies training needs within the team and/or department.
Manages, implements and coordinates an internal quality control program in conjunction with the internal quality control (iqc) department and provides reasonable assurance that pard has established, as well as is following, adequate policies, procedures, and is following applicable auditing standards.
Facilitates the development of quality management system (qms) policies and procedures.

Auditor accountabilities

Performs audit functions including those which are non-routine; keeps track of instructions for many projects simultaneouslyPresents and defends adjustments and workpapers to provider with minimal consultation from manager.
Coordinates large audits and/ or diverse audits independently while seeking help on truly unusual or major items.
Uses professional communication techniques in own and auditor’s work and in conclusions drawn from the work.
Establishes and maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate imageAdvises providers on medicare policy questions and directs non-pard area questions to responsible departments or personnel.
Conducts entrance and exit conferences and meetings away from office as needed.

To perform this job successfully, you must be able to perform each essential duty satisfactorilyReasonable accommodations may be made to enable individuals with disabilities to perform the essential functionsThis list of essential job functions is not exhaustive and may be supplemented as necessary.

What you must have:

Bachelors’/master’s degree with a concentration/major in accounting or financeBachelor’s/master’s degree in other fields can qualify if the candidate has 15 or more credit hours in specific accounting or finance classes.
Experience performing uniform desk review (udr) and an audit for a large or complex hospital, as the in-charge auditor
Experience reviewing medicare bad debts, inclusive of all relevant sample selection and testing according to cms standards
Experience reviewing dsh, inclusive of all relevant sample selection and testing according to cms standards
Experience reviewing ime/gme, inclusive of reviewing rotation schedules, bed count and all relevant testing according to cms standards
Experience reviewing and approving all work papers.
Experience with sample testing, transferring of testing to the audit adjustment report, and explaining the adjustments to a provider with the achievement of understanding by the provider
Experience assistance to audit management in the assignment and monitoring of workload, as well as leading junior team members

Nice to have:

A review of nursing & allied health education (nahe), inclusive of calculating the additional add-on payment and all relevant testing
A review of organ acquisition costs, inclusive of all relevant testing

Mba
Cpa

`we are an equal opportunity employer/protected veteran/disabled`

Our company requires applicants to provide documentation of being fully vaccinated against covid-19 unless legally entitled to an accommodationThe federal government and the centers for medicare & medicaid services (cms) may require applicants to have lived in the united states for a minimum of three (3) out of the last five (5) years to be employed with the companyThese years of residence do not have to be consecutive.