Provider Audit and Reimbursement Manager (CMS)

Job Description

Job Description

PROVIDER AUDIT AND REIMBURSEMENT MANAGER (CMS) - REMOTE

ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Manager (CMS)! Must have experience with Medicare Cost Reports. 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 Manager is responsible for managing a team of auditors and ensuring the work is performed in compliance with the Medicare laws and regulations, the standards set forth by the Centers for Medicare and Medicaid Services (CMS), the company's and department's quality and production standards, and the company's policies and procedures. The Manager will be responsible for either audit or reimbursement functions and can be responsible for one of four primary roles desk review / audit, reopenings / appeals, interim rate review / reimbursement or acceptance / finalization for all provider types as both a preparer and reviewer of work product. The Manager assigns annual workload budget, distributes assignments to the team, ensures timely and accurate completion and review of all work, and makes final reimbursement determinations for all work assigned to the team.

ESSENTIAL DUTIES & RESPONSIBILITIES :

• Manages team members and workload of the Audit / Reimbursement unit to ensure compliance with the standards set forth by CMS. The standards are in the form of Medicare laws and regulations and budget dollars granted for completion of the workload. (20%)
• Manages the daily activities of the Audit / Reimbursement unit, coordinates their interactions with other departments and numerous external entities. Assigned team members can be in more than one office location. (20%)
• Coordinates and manages the reimbursement for services, ensures that assigned team members update interim rates and other payment factors, ensures that all changes are entered into the claims processing system, and produces credible output reports that capture all relevant claim payment data required for cost report preparation and settlement. (5%)
• Coordinates the testing and validation of the pricing software releases installed in the payment system. (5%)
• Manages audits, provides direction to team members via work assignments, coordinates subordinate duties and provides guidance on audit issues. (5%)
• Maintains and controls audit and appeal assignments, and also schedules resources to meet performance requirements. (5%)
• Ensures that the Provider Audit unit completes its assigned objectives within the limits of established quality, policies, regulations and budgets. Determines the initial plan of audit work to be performed at desk and in the field for all assigned units. (5%)
• 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. (5%)
• Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal Government regulations for each class / type of provider within area of responsibility. (5%)
• Makes accounting decisions relative to audits, conferring, when necessary, with Senior Manager or Director on audit problems and / or interpretations of regulations. (5%)
• Reviews completed audit reports and approves them prior to the Senior Manager's or Director's review. (5%)
• Attends entrance and exit conferences, lends assistance to auditors as required, and follows up on audit recommendations. Reviews, researches and / or answers inquiries from governmental and other agencies regarding findings made on provider cost reports. (5%)
• Researches and reviews all written policies as related to the interpretation and application of governmental regulations on a consistent basis as affecting cost settlements. (5%)
• Attends meetings away from office as needed and renders assistance to providers by responding to inquiries. (5%)

REQUIRED QUALIFICATIONS

PREFERRED QUALIFICATIONS

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.