Provider Audit and Reimbursement Manager (CMS)
Location: Jacksonville, FL
Job Type: Direct Placement
Company: ARC Group
Category: Administration
Job Description Apply Now
Provider Audit and Reimbursement Manager (CMS) Job OverviewThe Provider Audit and Reimbursement Manager (CMS) is a critical leadership role responsible for overseeing audit and reimbursement functions within the organization, with a specific focus on compliance with Medicare and Centers for Medicare and Medicaid Services (CMS) regulations. This full-time, remote position is ideal for individuals with deep experience in Medicare cost reports and a strong background in accounting, finance, or a related field. As a Provider Audit and Reimbursement Manager (CMS), you will lead a team of auditors, ensuring accuracy, regulatory compliance, and high-quality service delivery. This opportunity offers professionals the chance to contribute to a respected organization recognized for its commitment to integrity and career growth.
Responsibilities- Manage the daily activities and workload of the audit and reimbursement team to ensure full compliance with CMS regulations, Medicare laws, and internal company policies.
- Oversee team assignments, distribute annual workload, and ensure timely, accurate completion of all audit and reimbursement tasks.
- Supervise audit or reimbursement functions, which may include desk reviews, reopenings, appeals, interim rate reviews, and final report acceptance for all provider types.
- Coordinate interactions between the audit/reimbursement team and other departments as well as external entities, maintaining effective communication and workflow management.
- Direct the reimbursement process, including updating interim rates, entering payment factors into claims processing systems, and generating comprehensive output reports for cost report preparation and settlement.
- Lead the validation and testing of pricing software releases within the payment system to ensure accuracy and compliance.
- Supervise audits, set work assignments, provide guidance on audit issues, and maintain control over audit and appeal assignments.
- Plan and execute audit work at both desk and field levels, ensuring adherence to established quality standards, regulatory requirements, and budgetary constraints.
- Review auditors’ workpapers for accuracy and compliance with Generally Accepted Accounting Principles (GAAP), Generally Accepted Auditing Standards (GAAS), Government Auditing Standards (GAS), and CMS Uniform Desk Review (UDR) policies.
- Evaluate and approve disbursements for tentative cost settlements as required by federal government regulations for multiple provider classes.
- Make accounting decisions regarding audits and consult with senior management as necessary for complex issues or regulatory interpretations.
- Review completed audit reports, provide final approval, and participate in management review processes.
- Attend and contribute to entrance and exit conferences, provide support to auditors, and respond to inquiries regarding audit findings from governmental and other agencies.
- Research and maintain up-to-date knowledge of governmental regulations as they apply to cost settlements and ensure consistent application in audit processes.
- Participate in meetings as needed, provide assistance to providers, and respond professionally to stakeholder inquiries.
- Bachelor’s or Master’s degree in Accounting or Finance, or in another field with at least 15 credit hours in accounting or finance coursework.
- Minimum of four years of relevant experience in Medicare audit and reimbursement, including at least three years in supervisory, project management, or leadership roles.
- Strong oral and written communication skills, with the ability to present information clearly and professionally.
- Demonstrated ability to exercise independent judgment and discretion in decision-making.
- Exceptional attention to detail and organizational skills.
- Master of Business Administration (MBA).
- Certified Public Accountant (CPA) certification.
This Provider Audit and Reimbursement Manager (CMS) position is remote, supporting eastern time zone business hours. The role is open to qualified professionals in approved states, with some locations offering in-office or hybrid options. Working remotely provides flexibility while fostering collaboration within a high-performing team. The organization values diversity and inclusion and is committed to supporting professional development and career advancement.
Equal Employment OpportunityAt ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.