[Hiring] Provider Audit and Reimbursement Manager @American Recruiting & Consulting Group

Role 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
• 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.

Qualifications

• Bachelors'/Master's degree with a concentration/major in Accounting or Finance. Bachelor's/Master's degree in other fields can qualify if the candidate has 15 or more credit hours in specific Accounting or Finance classes.
• 4 years' related work experience in Medicare audit and reimbursement, including 3 years supervisory/project management lead or other leadership experience.
• Demonstrated oral and written communications skills.
• Demonstrated ability to exercise independent judgement and discretion.
• Demonstrated attention to detail.

Requirements

• Manages team members and workload of the Audit/Reimbursement unit to ensure compliance with the standards set forth by CMS. (20%)
• Manages the daily activities of the Audit/Reimbursement unit, coordinates their interactions with other departments and numerous external entities. (20%)
• Coordinates and manages the reimbursement for services, ensures that assigned team members update interim rates and other payment factors. (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. (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. (5%)
• Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP). (5%)
• Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal Government regulations. (5%)
• Makes accounting decisions relative to audits, conferring with Senior Manager or Director on audit problems. (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. (5%)
• Researches and reviews all written policies as related to the interpretation and application of governmental regulations. (5%)
• Attends meetings away from office as needed and renders assistance to providers by responding to inquiries. (5%)

Benefits

• 100% remote work opportunity.
• Direct hire FTE position.
• Tremendous career growth potential.