Medicare Auditor

Blue Cross Blue Shield Association • Full-time • Remote (Birmingham, AL, US) • 3m ago

Overview

Department Overview

The Audit Department at our subsidiary has associates working remotely in several states with physical offices located in Birmingham, AL. This unit is responsible for work related to audits and appeals for a subset of institutional providers located across the country. The audit sector conducts Medicare audits on provider cost reports to determine payment and calculates the final settlement determination on the audited cost reports. The audit area also handles cost report appeals and reopenings from various other Medicare contractors, as assigned by the Medicare Administrative Contractors (MACs).

Primary Responsibilities

The incumbent will assist with work related to audits and special projects, as well as work related to appeals under direct supervision when assigned. All work must be completed within budget allocations, as well as in a manner that meets or exceeds quality expectations and contracting requirements.

The work related to audits must be performed in accordance with Generally Accepted Accounting Principles (GAAP), Generally Accepted Auditing Standards (GAGAS), governing regulations, issued instructions, and internal policy and procedure manuals. Duties can include any one or more of the following tasks: requesting documentation; completing regulatory research; performing audit work; incorporating adjustments; and making recommendations for final settlement.

In addition, when appeals work is assigned, the incumbent will perform all work in accordance with all board policies, rules, procedures, timeframes, and instructions. Duties can include any one or more of the following tasks: drafting preliminary/final position papers; initiating discovery requests; handling reopening requests; completing jurisdictional challenges; and executing administrative resolutions.

The incumbent must continuously handle all information, documents, data, and interactions in a secure and confidential manner. Further, the incumbent must perform at all times in a professional manner as a representative of our subsidiary, the government, and other entities.

Over time, the incumbent is expected to develop and apply an appropriate level of knowledge, skills, and understanding of work at the Staff Auditor level in order to meet developmental goals and to be considered for potential promotion.

Summary of Qualifications

Bachelor’s degree in Accounting, Finance, Business Administration, or other job-related field of study with a minimum of 12 semester hours of accounting classes
Demonstrated computer proficiency including Microsoft Office products, including Excel and Word
Problem solving, organizational, and time management skills that allow for the prioritization of work to meet timeframes, deadlines, and budget/resource requirements
Experience communicating clearly and effectively in oral and written form
Strong interpersonal skills and experience maintaining professionalism in all situations
Experience taking direction to ensure quality and accuracy of the work performed, as well as accepting feedback to improve performance and develop skills
Experience working independently and contributing as part of a team to complete assigned work
Prior work experience in the areas of healthcare/audit; or in lieu of specific work experience, possess a basic understanding of the healthcare/audit environment that would form the basis for developing required audit knowledge, skills, and aptitude, is preferred
Experience comprehending Medicare reimbursement principles, is preferred
Certified Public Accountant (CPA) is preferred

Terms and Agreements

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.

We appreciate your interest in 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.

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