[Hiring] PARD Settlement Associate 1-Novitas @GuideWell Source

Role Description

The Provider Audit and Reimbursement Settlement Associate position's primary role is to process the acceptability of annual Medicare cost reports and to accurately and timely process final settlement of less complex healthcare providers (non-hospitals).

Essential Responsibilities

• Processes Cost Report Settlement of less complex healthcare providers including Skilled Nursing Facilities (SNF), End Stage Renal Disease (ESRD), Community Mental Health Clinics (CMHC), Rural Health Clinics (RHC) and Home Office cost statements submitted by Audit. After a thorough review of all edits and results, the final product is the issuance of the Notice of amount of Program Reimbursement letter and adjusted cost report print out which indicates the final balance due. This information is forwarded to Accounts Receivable for disbursement or collection and it is also transmitted electronically to CMS. (35%)
• Processes Cost Report Acceptance of less complex healthcare providers including SNF, ESRD, CMHC, RHC and Home Office cost statements which includes acceptance or rejection. Staff has the ability to determine rejections but must be approved by Team Lead or above. (20%)
• Responsible for compiling and maintaining data logs, processing incoming and outgoing mail, scanning functions, report compilation, data preparation, as well as record filing and retrieval. (15%)
• Resolves discrepancies and may communicate with a variety of administrative and professional employees within and outside the organization. (15%)
• Responsible for reviewing and interpreting cost reporting instructions, CMS instructions and any Technical Direction Letter (TDLs) issued by CMS to make an informed decision on any discrepancies. Must get high level staff approval. (10%)
• Responsible for meeting quality and productions standards established by management. (5%)
• Performs other duties as the supervisor may, from time to time, deem necessary.

Qualifications

• High School Diploma or GED
• 2 years' related work experience including general accounting or Medicare reimbursement
• Demonstrated proficiency in MicroSoft Office applications including Word and Excel

Preferred Qualifications

• Associate Degree in Accounting
• Basic understanding of reimbursement methodologies and Medicare cost report flow

Requirements

• The 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) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.
• Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment.
• Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.

Benefits

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

Company Description

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.