[Hiring] Reimbursement Auditor @Aston Carter

Role Description

This role focuses on performing Medicare and Medicaid reimbursement audits and reviewing hospital and provider cost reports to ensure that healthcare organizations receive accurate and compliant reimbursement. The Reimbursement Auditor reviews underlying financial information and supporting documentation used to substantiate reported healthcare costs, analyzes reimbursement methodologies, and identifies discrepancies and compliance issues as part of a large-scale healthcare reimbursement and cost report review initiative.

• Perform detailed Medicare and Medicaid reimbursement audits and comprehensive healthcare financial reviews.
• Review and analyze hospital and provider cost reports for accuracy, completeness, and compliance with applicable regulations and guidelines.
• Audit financial documentation and supporting schedules used to substantiate reported healthcare costs and reimbursement amounts.
• Review Medicare cost reports, Medicaid reimbursement calculations, DSH-related information, and supplemental payment calculations based on assigned engagements.
• Identify discrepancies, unsupported costs, reimbursement issues, and potential compliance concerns within provider submissions.
• Analyze provider financial information, expenses, cost allocations, utilization data, and other supporting documentation to validate reported figures.
• Perform reconciliations and validate reported amounts against underlying financial records and source documents.
• Conduct root-cause analysis of reimbursement discrepancies and clearly document audit findings and conclusions.
• Prepare detailed supporting audit workpapers and document conclusions, recommendations, and rationale in a clear and organized manner.
• Communicate audit findings, questions, and requests for additional documentation to healthcare providers and internal project stakeholders in a professional manner.
• Support reviews involving state Medicaid programs, Medicare reimbursement, hospitals, health systems, physician and provider organizations, and healthcare networks.
• Apply knowledge of healthcare reimbursement regulations, methodologies, and cost reporting requirements throughout the audit process.
• Assist with recommendations for process improvements related to reimbursement reporting, audit readiness, and compliance practices.

Qualifications

• Experience performing healthcare reimbursement audits, cost report audits, or healthcare financial reviews.
• Prior experience with Medicare and/or Medicaid reimbursement.
• Hands-on knowledge of hospital cost reports and provider reimbursement processes.
• Ability to interpret detailed financial records and supporting documentation.
• Strong analytical skills and proficiency in performing reconciliations.
• Strong attention to detail and ability to identify inconsistencies in large volumes of financial data.
• Advanced proficiency with Excel and financial analysis tools.
• Ability to document audit procedures and findings clearly, accurately, and comprehensively.

Requirements

• Bachelors degree in Accounting, Finance, Business, Economics, Healthcare Administration, or a related field, or an associate degree supplemented by relevant experience.
• Experience with Medicare Cost Reports.
• Experience with Medicaid Cost Reports and Medicaid reimbursement methodologies.
• Familiarity with CMS-2552-10 and related cost reporting requirements.
• Experience with DSH (Disproportionate Share Hospital) programs.
• Experience with supplemental payment programs and calculations.
• Background in provider reimbursement and payment methodologies.
• Experience in Medicare and Medicaid audit activities.
• Exposure to healthcare financial review and reimbursement compliance.
• Understanding of revenue cycle processes and claims processing in healthcare settings.

Benefits

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Company Description

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence.