Provider Auditor I - Remote

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

Department: Provider Audit

Telecommuting Eligible: Yes

Job Grade: N14

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

Job Title

Provider Auditor I

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 the ability to develop 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.
• Initiates, plans, conducts, and finalize audits of financial, management, and administrative procedures of assigned cost reports. Responsible for determining appropriate scope and procedures for each individual review. Analyzes audit program to determine proper procedures are performed based on scope.
• Provides independent judgement and decisions regarding reviews and minimizes risk for organization and quality control.
• Participates in and facilitates meetings, entrance conferences, walkthroughs and exit conferences with external providers.
• Requires ability to develop knowledge of documentation requirements from audit testing through preparation of audit workpapers.
• Possesses excellent written and verbal communication skills needed to draft, deliver, and issue corrective action plans for audit adjustment reports to consultants, CPA firms, management and provider executives.
• Performs risk analysis on provider financial statements to determine impact of potential risk of Medicare dollars.
• Must obtain a minimum of 80 CET hours every two years.
• Provides proactive support and process improvement by participating in special projects, documenting work as prescribed by the project. Collaborates with internal and external customers to determine and distribute requested information and documentation.

Non-Essential Duties and Functions

• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Accounting, Business, Finance or equivalent work experience
• Knowledge of accounting theory and practices
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint)

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: $19.05 – $31.34

Other Compensation: Incentive Plan

Lifestyle Benefit: $50/month

This job will be closed 02/02/2024 at 8:00AM CST. No further applications will be considered.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)