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Job Position Description
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Pinnacle Business Solutions
EXEMPT POSITION DESCRIPTION
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| Position: |
Auditor |
Job Code: |
031206 |
Min Salary: |
35500 |
| Reports To: |
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Date: |
5/16/2005 |
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| Division: |
Provider Audit & Reimb (5011) |
Company: |
PINNACLE |
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Job Summary
This position is accountable for the performance of desk review and audit procedures as assigned by the Team Supervisor or Senior Auditor, in order to timely and accurately process Statements of Medicare Reimbursable Costs as filed by providers of health care services. |
Nature & Scope
The Auditor is part of a team consisting of a Supervisor, Senior Auditors and/or other staff Auditors, and a Cost Report Specialist. The Auditor is responsible directly to the Team Supervisor, and then to the Senior Auditors in the absence of the Supervisor. The audit team, as a whole, is responsible for the annual desk review, audit and settlement of Medicare cost reports for approximately 140 institutional health care providers (hospitals, skilled nursing homes, home health agencies, etc.).
Providers of health care services receiving payment under Part A of Medicare are subject to audit for all costs applicable to Program beneficiaries. The audit is made to ensure that proper payments are made in compliance with applicable law, regulation and policy, to provide verified financial information for making a final determination of allowable costs, and to develop such other information as may be required by the Centers for Medicare and Medicaid Services (CMS). Through the audit process, the audit team certifies to the accuracy of annual reimbursement paid to the providers under the team’s responsibility.
In the performance of job responsibilities, the Auditor will be expected to assist in the professional desk review of the cost reports. As expertise and experience are gained in this function , the Auditor will be expected to assume certain responsibility for scope determination and preparation of the audit program.
The Auditor will also assist the Audit Supervisor, Senior Auditor or In-Charge Auditor in the audit of cost reports. An audit may take the form of field review or may be a desk audit situation handled by mail or phone contacts with the provider. In any audit situation encountered, The Auditor will be expected to perform activities assigned in accordance with current Division policies and the Guidelines for Provider Audits attached. Many standard audit workpapers and other aspects of the review of the cost report are performed using electronic spreadsheets. The Auditor is thus expected to be proficient in the use of the applicable computer software.
During and after completion of the field audit or desk audit, the Auditor may prepare or check adjustment reports reflecting audit adjustments, rework cost reports incorporating audit adjustments, or perform settlement reviews of the reworked cost reports as necessary. Adjustment reports and reworked cost reports are prepared using electronic cost report processing software, which the Auditor will be expected to become proficient in using. Other job functions for the Auditor include aiding in training or instruction of less experienced Auditors, assisting in special projects as required by CMS or internal operations, and the assumption of more advanced duties as may be necessary according to expertise and experience. Appropriate authority will be given to an Auditor acting in the capacity of an In-Charge auditor. Normally, in-charge assignmThe aforementioned job responsibilities will require that the Auditor travel a certain amount of time, depending on the nature of the audit work to be performed and requirements placed on field review by CMS. Travel time will vary from year to year, but may range from as low as 20% to as high as 60% of an auditor’s time.
The Auditor must also work closely and be able to communicate regarding audit and reimbursement matters with provider personnel and the provider’s independent accountant. As expertise is gained in audit functions, the Auditor must be able to successfully resolve areas in dispute and provide consultative services where necessary. Initially, the degree of problem solving at the Auditor level will be somewhat limited due to the inexperience of the Auditor. However, the auditor will be expected to use problem solving techniques in applying the audit skills learned since each audit will present different problems or situations to be analyzed in reaching a conclusion. With increased experience, the Auditor will be expected to research answers for new or unfamiliar areas and also to seek and make recommendations to team management for the resolution of an audit situation.
As noted before, the primary purpose of the audit of a Medicare cost report is to provide assurance that the payments made under the Medicare Program are valid. Accordingly, Auditors must have the skills necessary to perform financial audits and render opinions or judgements on audit work performed. These skills include a thorough knowledge of accounting and auditing theory and procedures, business law , and the education, ability and expertise to apply such knowledge to audit situations. To audit for the Medicare Program, a thorough knowledge of Medicare principles of reimbursement and the ability to apply this knowledge and skills to the audit of a Medicare cost report are essential. Since the job market cannot supply candidates with Medicare audit experience this knowledge and skill is developed through on-site training.
In compliance with Generally Accepted Government Auditing Standards, the Auditor is expected to obtain a minimum of 80 hours of Continuing Professional Education (CPE) every two years. This training will be coordinated for the entire audit staff by Division Management.
The Auditor will be evaluated on the ability to perform delegated job functions and the attitude taken toward the duties and responsibilities assigned. At the recommendation of the Audit Supervisor, after minimum of 2 years on the Provider Audit staff, the Auditor may be considered for promotion to Senior Auditor. It is expected that during that time, the Auditor will have successfully completed a number of cost report desk audits, and competently served as in-charge auditor on a minimum of five audits.
ents will begin after nine months to one year experience in the Division.
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Minimum Job Requirements
Knowledge of personal computers, in particular, use of Excel,Word, and Access.
Knowledge of accounting and auditing theory and procedures.
Knowledge of Medicare principles of reimbursement and cost report processing software, (KPMG Compumax, FIRST, etc.)preferred.
1. A college or university degree in accounting or an equivalent degree so long as the courses taken would parallel an accounting degree AND be eligible to take CPA exam.
2. Audit experience preferred.
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Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
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Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
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PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES
(Essential Functions of Job)
Answer directly to the Audit Supervisor for the performance of assigned duties. In the absence of the Supervisor, the Auditor is responsible to the Senior Auditor on the team.
Perform all assignments in accordance with acquired knowledge in that area and in accordance with the Guidelines for Provider Audits attached.
Meet budgeted production set forth by the Supervisor. Overtime will be expected if necessary to complete the assigned activities within the time allotted.
Aid in all aspects of the desk review and audit process including special projects as may be necessary.
Perform certain Senior Auditor responsibilities as expertise is gained in the audit and settlement process.
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******* END *******
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Employee Benefits
Our very competitive package of Employee Benefits
includes everything from tuition reimbursement to 401(k) savings plans.
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