Provider Auditor II - PRRB Appeals

* Position is eligible for Remote / Work from Home opportunity *

Department: Provider Audit- Cost Report Appeals

Telecommuting Eligible: Yes

Job Grade: E10

Notice of Collection & Privacy Policy for Applicants Residing in California: California Applicant Privacy Policy | Noridian (noridiansolutions.com) 

Job Title

Provider Auditor II

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

• Requires an intermediate level of working knowledge of Medicare rules, regulations (e.g., Code of Federal Regulations, Provider Reimbursement manual) to ensure reimbursement principles are properly applied to the Medicare Cost Report so that Medicare reimbursement is accurate
• Mentors Auditor I and Auditor II level staff by training, coaching, and providing constructive and positive feedback
• Identifies areas of opportunity, provides solutions and works towards implementation and/or training, documenting the updates and procedures for efficiency and process improvement
• Provides support and input for specialized and in-depth projects with increased complexity
• Resolves cost report reopening requests as assigned, reviewing documentation submitted to determine accuracy of the request and proposing applicable adjustments to the cost report
• Works with externally facing provider representatives when necessary to resolve appeal cases, including writing position papers and auditing documents
• Possesses ability to Lead basic audits
• Requires advanced knowledge of documentation requirements from audit testing through preparation of audit workpapers
• Must obtain a minimum of 80 CET hours every two years.

Non-Essential Duties and Functions

• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Accounting, Business, Finance or equivalent work experience
• 1-year Medicare auditing experience
• Knowledge of accounting theory and practices
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint)
• Demonstrated knowledge of Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software)

Preferred Qualifications

Above requirements and the following:

• Bachelor's degree in Accounting, Business or Finance
• Excellent written and verbal communication skills
• Excellent organizational 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.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions.  Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity. 

Below is the salary range for potential new hires.

Salary Range:  $45,322– $74,542

Other Compensation: Incentive Plan

Lifestyle Benefit: $50/month

This job will be closed 09/15/2023 at 8:00AM CST.  No further applications will be considered.

Salary : $45,322 - $74,542