Provider Audit Lead (CMS)
Location: Jacksonville, FL
Job Type: Direct Placement
Company: ARC Group
Category: Administration
Job Description Apply Now
Provider Audit Lead (CMS) Job OverviewARC Group is seeking a highly skilled and experienced Provider Audit Lead (CMS) for a full-time, remote position. This role focuses on leading and overseeing comprehensive Medicare cost report audits in accordance with regulations set forth by the Centers for Medicare and Medicaid Services (CMS). The Provider Audit Lead (CMS) position offers an excellent opportunity for career advancement within a reputable organization recognized for its commitment to integrity and technical excellence in the healthcare auditing sector.
Key Responsibilities- Lead and coordinate the daily workload of auditing teams, ensuring that all audit tasks are prioritized and completed within established deadlines for various provider types, including complex hospitals and organ transplant centers.
- Mentor, train, and provide constructive feedback to both new and experienced auditors, supporting their professional development and technical proficiency in Medicare cost report auditing and compliance with CMS standards.
- Review and analyze working papers and cost reports to ensure accuracy, compliance with Generally Accepted Accounting Principles (GAAP), Generally Accepted Auditing Standards (GAAS), and Government Auditing Standards (GAS), and alignment with CMS Uniform Desk Review (UDR) policies.
- Oversee the disbursement and approval of tentative cost settlements for providers, ensuring compliance with Federal and State Government regulations.
- Implement and manage internal quality control programs in collaboration with the Internal Quality Control (IQC) department, ensuring adherence to departmental policies and procedures as well as applicable auditing standards.
- Contribute to the development and maintenance of Quality Management System (QMS) policies and procedures.
- Independently conduct complex and large-scale audits, present and defend audit adjustments and findings to providers, and maintain professional communication throughout the audit process.
- Establish and nurture constructive provider relations by offering guidance on Medicare policies and directing inquiries to the appropriate departments or personnel.
- Conduct entrance and exit conferences, and facilitate meetings as needed, sometimes away from the primary work location.
- Assist audit management with workload assignments and monitor progress, serving as a resource and leader for junior team members.
- Perform other related duties as assigned by management, ensuring comprehensive coverage of all auditing responsibilities.
- Bachelor’s degree in auditing, accounting, analytics, finance, or a related field; or equivalent combination of education and relevant experience.
- Minimum of 2.5 to 3 years of direct Medicare cost report auditing experience, including responsibility for Uniform Desk Reviews (UDR), Medicare Bad Debts, Disproportionate Share Hospital (DSH) reviews, Indirect Medical Education/Graduate Medical Education (IME/GME) reviews, and oversight of audit scope and work papers.
- Demonstrated leadership skills, including experience mentoring junior auditors or serving as a Subject Matter Expert (SME), and involvement in formal training or special projects.
- Strong proficiency with applicable software applications used in auditing and cost reporting.
- Proven ability to prepare detailed workpapers in line with CMS standards and to communicate audit findings clearly in both oral and written formats.
- Excellent independent judgment, attention to detail, and ability to meet deadlines while maintaining high standards of quality and professionalism.
- 3 to 4 years of Medicare cost report auditing experience.
- Demonstrated experience with Nursing & Allied Health Education (NAHE) reviews, including calculation of add-on payments and Organ Acquisition cost reviews.
This Provider Audit Lead (CMS) position is full-time and fully remote, supporting business operations in the Eastern Time Zone. The role is open to candidates residing in approved states, with additional opportunities in some locations for hybrid or in-office arrangements. Working remotely for ARC Group provides flexibility while being part of a collaborative and respected team.
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.