GuideWell Source PARD Auditor in Dallas, Texas
The Provider Audit and Reimbursement Auditor position can fill three primarily roles – desk review/audit, interim rate review, and acceptance/finalization for all provider types.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Reviews the cost report and provider statistical and reimbursement report (PS&R) information to determine accurate and timely Skilled Nursing Facility (SNF), End Stage Renal Disease (ESRD) and Federally Qualified Health Centers (FQHC)/Rural Health Clinics (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 determine lump-sum adjustments for interim rate accuracy.
• Performs limited desk reviews of cost reports for SNF, ESRD, and FQHC/RHC 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.
• Assists the senior and/or In-Charge auditor in performing hospital audits. Performs post audit activities involving follow-up with provider representatives and preparing the final cost report package.
• Serves as a specialist over one or more various projects that could include; duplicate interns and residents (IRIS) data, transmission of cost report information (HCRIS), wage index submissions, system for tracking audit and reimbursement (STAR) updates including the tracking of providers, cost reports and continuing education and training (CET), HFS cost report software, SNF pass through logs, and PS&R backup.
• Assists management in the administrative functions of the department including creating and maintaining electronic and hard copy provider cost report files, participating in continuous improvement projects, etc.
• Attends meetings away from office as needed.
Performs other duties as the supervisor may, from time to time, deem necessary.
• Bachelors degree in Accounting, Finance, Business Administration or 4 years equivalent work experience)
“Novitas-Solutions is an Equal Opportunity Employer/Protected Veteran/Disabled
Requisition ID: 8208