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Medicare Cost Report Auditor III

Role overview

Qualifications

  • Bachelor's in a job related field
  • 5 years auditing experience
  • Knowledge of the principles and practices of auditing
  • Excellent analytical or critical thinking and problem-solving capabilities

Responsibilities

  • Conducts internal and/or external operational, financial, and/or compliance audits
  • Identifies, documents, and evaluates business risks
  • Develops written audit programs and conducts testing of existing controls
  • Drafts recommendations to limit risks and improve processes

About the company

CGS Administrators, LLC logo

CGS Administrators, LLC

Government Administration

CGS performs all phases of administrative services for healthcare providers and health plan members. For providers, we handle provider credentialing, re-verification, and maintenance, call center services, and outreach and education. We also provide Medical Review strategy development, implementation, and data analysis. For members, we provide call center services. Additionally, CGS handles all aspects of claims processing from initial receipt, to payment, to overpayment recovery and appeals, all while leveraging the latest technology solutions. CGS currently provides Medicare Part A claims processing and customer support services in the states of Kentucky and Ohio. CGS also provides services for Home Health and Hospice in the states of Colorado, Delaware, DC, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, and Wyoming. In addition, we provide services for Medicare Part B in the states of Ohio, Kentucky, and Idaho, and we provide service to Durable Medical Equipment suppliers in the states of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.

Company details

Company typeSME
IndustryGovernment Administration
Company size501 - 1000

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Job description


Summary
 

Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources.


Description
 

The Auditor position is a full-time (40 hours) remote position with a flexible schedule that can include working 4 days per week. This position has the ability to work from any US location.

What You'll Do:

  • Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls. Identifies, documents, and evaluates business risks. Develops written audit programs. Conducts testing and analysis of existing controls to determine adequacy and effectiveness. Prepares written work papers to document testing results and conclusions reached. Documents issues, the causes of those issues, and their effects on the process/function and the corporation. Serves as Lead Auditor on more complex audit assignments.
  • Drafts recommendations to limit risks and improve processes, functions and activities. Writes audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions and recommendations. Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies. Conducts testing of corrective actions as identified.
  • Develops detailed reports on each audit conducted. Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes. Examine and evaluate financial and information systems, recommending controls to ensure system reliability and data integrity.
  • Conducts special audit studies for management, such as those required to discover controls for prevention of fraud. Prepares reports of findings and recommendations for management.
  • Provides training to and assists or leads other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel.
  • Strives to expand knowledge of applicable laws, regulations, program instructions, and technology through self-study, corporate offerings, and formal training programs.

What You'll Need:


Required Education: Bachelor's in a job related field.
Required Experience: 5 years auditing experience.
Required Skills and Abilities:

  • Knowledge of the principles and practices of auditing.
  • Ability to analyze and determine the applicability of financial data, to draw conclusions and make appropriate recommendations.
  • Ability to gather information by examining records and documents and to interview individuals concerning those records.
  • Strong interpersonal skills and the ability to work professionally with persons at all levels, and to maintain effective working relationships.
  • Ability to communicate clearly and effectively in oral and written form.
  • Ability to handle sensitive matters on a confidential basis.
  • Excellent analytical or critical thinking and problem-solving capabilities.


Required Software and Tools: Microsoft Office.

Preferred Education: Bachelors in Accounting/Finance or 12 credit hours

Preferred Experience:

  • Lead auditor for Uniform Desk Reviews (UDRs) and complex hospital audits
  • Minimum 2 years of Medicare hospital cost report auditing experience
  • Expertise in Medicare Bad Debt and DSH cost report reviews, including sample selection and CMS-compliant testing
  • Skilled in Nursing and Allied Health Education (NAHE) legal operator determinations and add-on payment calculations

Preferred Licenses and Certificates: Certified Internal Auditor (CIA), Certified Public Accountant (CPA), or Certified Information Systems Auditor (CISA)

Work Environment: Typical office environment. Travel between office buildings and out of town may be required.

Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits at the first of the month following 28 days of employment:

  • Subsidized health plans, dental and vision coverage
  • 401k retirement savings plan with company match
  • Life Insurance
  • Paid Time Off (PTO)
  • On-site cafeterias and fitness centers in major locations
  • Education Assistance
  • Service Recognition
  • National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Salary Range:

Range Minimum

$57,790.00

Range Midpoint

$84,089.00

Range Maximum

$110,388.00

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

Some states have required notifications. Here's more information

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

Some states have required notifications. Here's more information

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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