Reference #: GUIDUS33856EXTERNALENUS10503
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.
Benefits info:
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
SUMMARY STATEMENT
The Provider Audit and Reimbursement Audit Associate 2 position is responsible for completing tentative settlements and desk reviews on Skilled Nursing Facilities (SNF), End Stage Renal Disease (ESRD) and Federally Qualified Health Centers/Rural Health Clinics (FQHC/RHC) providers.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
Reviews cost report and Provider Statistical and Reimbursement report (PS&R) information to determine accurate and timely SNF, ESRD and FQHC)/ (RHC) tentative settlements of bad debt payments or other pass-through costs. Reviews the cost report and accompanying bad debt logs to update pass-through payment amounts and determines lump-sum adjustments for interim rate accuracy. (35%)
Performs limited desk reviews of cost reports for SNF, ESRD, FQHC/RHC, and Balance Budget Act (BBA), BBA ESRD reviews for providers that receive Medicare reimbursement. Generates all required internal and external correspondence and checklists to facilitate implementation of and evidence of completion of the desk reviews. (35%)
Serves as a specialist over one or more various projects that could include duplicate interns and residents (IRIS) data, system for tracking audit and reimbursement (STAR) updates, including the tracking of providers, cost reports and continuing education and training (CET), Health Financial Systems (HFS) cost report software, SNF pass through logs, and PS&R backup. (15%)
Assists management in the administrative functions of the department including creating and maintaining electronic and hard copy provider cost report files, completing reconciliation reports, participating in continuous improvement projects, etc. (10%)
Performs other duties as the manager may, from time to time, deem necessary. (5%)
REQUIRED QUALIFICATIONS
High School Diploma or GED
4 years' related work experience; includes experience in Medicare cost reporting, which can include settlement, audit and/or reimbursement.
PREFERRED QUALIFICATIONS
Associate degree in Accounting
Two years' experience in healthcare accounting, auditing or reimbursement
Experience using HFS cost report software
This opportunity is open to remote work in the following approved states: AL,AK, FL, GA, ID, IN, IO, KS, LA, MS,MT, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY.
Specific counties and cities within these states may require additional approval. In FL, PA, TX and WI, in-office and hybrid work may also be available.
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."We are an Equal Opportunity Employer/Protected Veteran/Disabled"Novitas Solutions, Inc. is an Equal Opportunity Employer - Protected Veteran/Disabled