Senior Provider Auditor

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.

These positions are the face of Noridian interacting with providers / facilities management through the audit process which requires an advanced level of professionalism.

Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plans, and prepares / submits reports on the results of audits.

Essential Functions

Key Duties / Responsibilities / Accountabilities

• Mentors staff at all levels by training, coaching, and providing constructive and positive feedback
• Assists with new and existing employee training on department techniques, desk review and audit methodologies, policies and procedures
• Provides professional judgement, strategic insight, and guidance to Provider Auditor I and II’s using their knowledge, experience, and research to ensure quality control is adequate and minimize risk for the team and organization
• Performs supervisory level reviews and coaches staff with feedback to strengthen their knowledge and skills to perform job functions effectively and efficiently
• Enhances and maintains strong, professional working relationships with providers
• Requires extensive knowledge of documentation requirements from audit testing through preparation of audit workpapers
• Provides training to internal staff and participates in external outreach and education to the provider community

Non-Essential Duties and Functions

Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Accounting, Business, Finance, or equivalent work experience
• 3 years' Medicare auditing experience
• Knowledge of accounting theory and practices
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint)
• Advanced knowledge of Medicare rules, regulations (e.g., Code of Federal Regulations, Provider Reimbursement Manual) to ensure the reimbursement principles are properly applied to the Medicare Cost Report so that Medicare reimbursement is accurate

Preferred Qualifications

Above requirements and the following :

• 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 use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping

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.