Healthcare Provider Audit Specialist

2 weeks ago

Fargo, North Dakota, United States Noridian Full time

Position Overview:
This role offers the flexibility of Remote / Work from Home opportunities. The Healthcare Provider Audit Specialist is tasked with validating audit scope determinations, executing comprehensive evaluations of completed audits, conducting high-level desk assessments, and managing special projects while ensuring that workloads align with Medicare, corporate, and departmental standards and budgets.

Key Responsibilities:

1. Achieves contractual commitments and performance benchmarks, ensuring quality outcomes through effective performance management of team members and the implementation of internal controls.

2. Conducts intricate supervisory reviews and provides coaching to staff, offering constructive feedback to enhance their expertise and efficiency in job functions.

3. Prioritizes tasks, ensuring that workflow is continuously monitored and adjusted to meet internal and external deadlines.

4. Offers technical guidance and support to ensure team members meet performance expectations in collaboration with the relevant supervisor.

5. Regularly updates the Audit Supervisor regarding the technical performance of staff.

6. Contributes to the disciplinary process when necessary, ensuring that employee performance aligns with expectations and assists in the follow-up of disciplinary plans while documenting discussions and decisions accurately.

7. Encourages innovation and presents ideas for process enhancements and technological improvements.

8. Exemplifies leadership by fostering teamwork, recognition, and adherence to company values.

9. Adapts to changes with a positive and flexible approach.

Subject Matter Expertise:
Acts as a key resource for both internal and external stakeholders, including CMS, government representatives, provider representatives, and various contractors.

Collaborates with the training department to identify significant training needs and develop relevant curricula.

Serves as a point of contact for internal and external inquiries, including those from CMS and various contractors.

Provides a comprehensive analytical perspective on systems by maintaining an in-depth understanding of all systems and subsystems utilized in administering the Medicare program and other business lines.

May perform evaluations of departmental activities, including detailed analyses of complex reimbursement structures identified in Medicare cost reports, ensuring compliance with CMS and federal regulations.

Qualifications:
1. Bachelor's degree in accounting, business, or finance.

2. Advanced understanding of Medicare reimbursement principles and regulations, including the Medicare Cost Report.

3. Strong knowledge of accounting theories and practices.

4. Proficient in Medicare/Medicaid regulations, healthcare terminology, and various software applications, including Medicare Cost Report software (HFS Software).

5. Demonstrates a clear understanding of industry objectives and enterprise goals.

6. Excellent written and verbal communication skills.

7. Ability to foster effective interpersonal relationships within the workplace.

8. Strong problem-solving abilities and the capacity to develop technical problem-solving skills within team members.

9. Exceptional organizational skills and attention to detail.

10. Strong presentation capabilities.

Preferred Qualifications:
1. CPA or other relevant professional certification.

2. Advanced skills in Microsoft Office.

3. Ability to advise and educate others effectively.

4. Strong analytical skills.

Work Environment:
1. Ability to read, hear, speak, and utilize office equipment.

2. Normal hearing and vision range required.

3. Prolonged periods of sitting and telephone usage.

4. Occasional lifting of up to 15 pounds.

5. May require travel.

Equal Opportunity Employer:
Noridian is an equal opportunity employer, welcoming applicants from diverse backgrounds, including minorities, females, protected veterans, and individuals with disabilities.

Total Rewards Package:
Comprehensive benefits including health, dental, and vision insurance, voluntary insurance plans, retirement savings with company match, education assistance, paid leave, and wellness programs.

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