PARD Mgr

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 PARD Manager is responsible for managing a team of PARD team members and ensuring the work is performed in compliance with the Medicare laws and regulations, the standards set forth by the Centers for Medicare and Medicaid Services (CMS), the company’s and department’s quality and production standards, and the company’s policies and procedures. The Manager will be responsible for either audit or reimbursement functions and can be responsible for one of four primary roles – desk review/audit, reopenings/appeals, interim rate review/reimbursement or acceptance/finalization for all provider types as both a preparer and reviewer of work product. The Manager assigns annual workload budget, distributes assignments to the team, ensures timely and accurate completion and review of all work, and makes final reimbursement determinations for all work assigned to the team.

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.

• Manages team members’ and workload of the Audit/Reimbursement unit to ensure compliance with the standards set forth by CMS. The standards are in the form of Medicare laws and regulations and budget dollars granted for completion of the workload. (20%)
• Manages the daily activities of the Audit/Reimbursement unit, coordinates their interactions with other departments and numerous external entities. Assigned team members can be in more than one office location. (20%)
• Coordinates and manages the reimbursement for services, ensures that assigned team members update 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. (5%)
• Coordinates the testing and validation of the pricing software releases installed in the payment system. (5%)
• Manages audits, provides direction to team members via work assignments, coordinates subordinate duties and provides guidance on audit issues. (5%)
• Maintains and controls audit and appeal assignments, and also schedules resources to meet performance requirements. (5%)
• Ensures that the Provider Audit unit 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. (5%)
• Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (5%)
• Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal Government regulations for each class/type of provider within area of responsibility. (5%)
• Makes accounting decisions relative to audits, conferring, when necessary, with Senior Manager or Director on audit problems and/or interpretations of regulations. (5%)
• Reviews completed audit reports and approves them prior to the Senior Manager's or Director’s review. (5%)
• 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. (5%)
• Researches and reviews all written policies as related to the interpretation and application of governmental regulations on a consistent basis as affecting cost settlements. (5%)
• Attends meetings away from office as needed and renders assistance to providers by responding to inquiries. (5%)
  
  
  

Performs other duties as the supervisor may, from time to time, deem necessary.

Required Qualifications

• Bachelors’/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 15 or more credit hours in specific Accounting or Finance classes.
• 4 years’ related work experience in Medicare audit and reimbursement, including 3 years’ supervisory/project management lead or other leadership experience.
• Demonstrated oral and written communications skills
• Demonstrated ability to exercise independent judgement and discretion
• Demonstrated attention to detail
  
  
  

Preferred Qualifications

• Masters in Business Administration (MBA)
• Certified Public Accountant (CPA)
  
  
  

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.

This opportunity is open to remote work in the following approved states: AL, AK, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available.

"We are an Equal Opportunity Employer/Protected Veteran/Disabled"