- Dallas, TX, USA
- Permanent, Full time
- Florida Blue
- 28 Nov 17 2017-11-28
SUMMARY STATEMENT This position ensures that all standards, policies and procedures are followed on all work performed; creates the operating procedures used in the department; assigns annual workload budget and distributes to the staff and makes final reimbursement determinations for all work assigned to the unit.
ESSENTIAL DUTIES & RESPONSIBILTITIES
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.
* Supervises the staff and workload of the Audit/Reimbursement Unit to ensure compliance with the standards set forth by the Centers for Medicare and Medicaid Services (CMS). The standards are in the form of Medicare laws and regulations and budget dollars granted for completion of the workload.
* Supervises the daily activities of the Audit/Reimbursement unit, coordinates their interactions with other departments and numerous external entities. Staff can be in more than one office location.
* Establishes reimbursement for services, ensures that assigned staff updates interim rates and other payment factors, ensures that all changes are entered into the claims processing system, and produces credible output reports that capture all relevant claim payment data required for cost report preparation and settlement.
* Participates in the testing and validation of the pricing software releases installed in the payment system.
* Manages audits, provides direction to employees via work assignments, coordinates subordinate duties and provides guidance on audit issues.
* Maintains and controls audit and appeal assignments, and also schedules manpower to meet performance requirements.
* Ensures that the Provider Audit unit in PARD completes its assigned objectives within the limits of established quality, policies, regulations and budgets. Determines the initial plan of audit work to be performed at desk and in the field for all assigned units.
* May review work papers of auditors for correctness, control and adherence to GAAP and GAAS and GAS. Examines and reviews, upon completion of the field audit, working papers for proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence.
* Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal and State Government regulations for each class/type of provider within area of responsibility.
* Makes accounting decisions relative to audits, conferring, when necessary, with Senior Manager on audit problems and/or interpretations or regulations.
* Reviews completed audit reports and approves them prior to the Senior Manager's review.
* Attends entrance and exit conferences, lends assistance to auditors as required, and follows up on audit recommendations. Reviews, researches and/or answers inquiries from governmental and other agencies regarding findings made on provider cost reports.
* Researches and reviews all written policies as related to the interpretation and application of governmental regulations on a consistent basis as affecting cost settlements.
* Attends meetings away from office as needed and renders assistance to providers by responding to inquiries.
Performs other duties as the supervisor may, from time to time, deem necessary.
* Bachelor's/Master's degree with a concentration/major in Accounting or Finance. Bachelor's/Master's degree in other fields can qualify if the candidate has the requisite accounting or finance classes or is eligible to sit for the CPA exam.
* 4+ years' related work experience in Medicare audit and reimbursement, including 3+ years' supervisory/project management lead or other leadership experience.
We are an Equal Opportunity Employer/Protected Veteran/Disabled