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Job Title

Provider Audit Technical Reviewer

Job Summary

The Provider Audit Reviewer is responsible for approving the audit scope determinations, conducting full reviews of the completed audits, high level desk reviews, special projects and ensures workloads are current and operating within Medicare, corporate, and departmental guidelines and budgets.

Essential Functions
Key Duties/Responsibilities/Accountabilities

• Meets contractual obligations and performance standards, while ensuring quality performance through the performance management of staff and implementing internal controls.
• Performs complex supervisory level reviews and coaches staff with feedback to strengthen their knowledge and skills to perform job functions effectively and efficiently.
• Prioritizes workload, ensuring workflow is monitored and adjusted as needed to ensure workloads are completed in a timely manner based on internal and external standards.
  Provides technical coaching and direction to ensure staff are meeting expectations in partnership with the applicable supervisor.
• Provides continuous updates to Audit Supervisor on staff's technical performance.
• Provides input during the disciplinary action process when appropriate to ensure employee performance meets expectations. Assists Audit Supervisor with follow up for disciplinary plans and documents conversations and decisions appropriately.
• Provides ideas and encourages innovation in areas of process improvements and technology enhancements.
• Leads by example by promoting teamwork, recognition, and leadership while demonstrating company values.
• Responds to and implements change in a flexible, positive manner.
• Participates as the area subject-matter expert and resource for internal and external customers, which may include CMS, government officials, provider representatives, and other various contractors.
• Collaborates with the training team to identify substantive training issues and develop curriculum.
• Serves as a resource point for internal and external customers including CMS and various contractors.
• Provides analytical and broad-based view of systems by acquiring and maintaining a thorough knowledge of all systems and subsystems used to administer the Medicare program and other lines of business.
• May conduct reviews of all departmental activities, including in-depth analysis of complex reimbursement structures identified in the Medicare cost report which are in accordance with CMS and the Code of Federal Regulations.
• 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 or finance
• 5-years Medicare auditing experience
• Advanced knowledge of Medicare reimbursement principles and regulations and Medicare Cost Report
• Advanced knowledge of accounting theory and practices
• Proficient in Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software)
• Demonstrates an understanding of industry and enterprise objectives
• Demonstrates a technical understanding of systems, process and CMS and departmental guidelines
• Excellent written and verbal communication skills
• Ability to build effective interpersonal relationships within the workplace
• Ability to problem solve and develop technical problem-solving skills within staff
• Excellent organization skills and attention to detail
• Excellent presentation skills

Preferred Qualifications

Above requirements and the following:

• CPA or other professional certification
• Advanced Microsoft Office skills
• Possesses the ability to advise and educate others
• Strong analytical skills
• Advanced in Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software)

• Office Environment
• Ability to read, hear, speak, keyboard, reason and problem solve
• Normal hearing and vision range
• Requires prolonged sitting and telephone usage
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting up to 15 pounds
• Infrequent stooping
• Ability to travel

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.

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.

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: $59,937 - $98,582 per year

Other Compensation: Incentive Plan

This job will be closed 12/15/2023 at 8:00AM CST. No further applications will be considered.