Develops, Implements and maintains systems related to the calculation of third party reimbursement Manages the preparation of all third party reporting and the annual audit of the third party areaReviews all third party filings to ensure compliance and accuracy. Works with others to coordinate the filing of appeals Serves as resource/liaison to respond to needs of internal management, external auditors and consultants.Performs major role in monthly closing activities and financial statement preparationPrepare annual Medicare/Medicaid hospital cost reports Review analyze and ensure accuracy of financial and statistical reports presented to Management Collaborate with outside financial auditors and fiscal intermediary auditors Manage state Medicaid supplemental funding applications and calculations Manages personal activities, completion of performance reviews and continuous development of staff as appropriate

Coordinate and review processes throughout the System specific to Medicare cost report software implementation, usage and maintenance for HFS cost report software and• Responsible for teaching all Regions new reimbursement software to standardize a uniform Reimbursement processes during site visits, webinars and annual reimbursement meeting updates.• Prepare and review cost reports, completing comparative analysis of the cost report versus the financial statement and compliance checklist prior to submission, for assigned facilities. Timely completion of work is required to ensure Medicare, Medicaid and CHAMPUS cost reports are submitted by due dates to prevent loss of reimbursement to the facilities. Identify and pursue proper reimbursement methodologies in an effort to receive all reimbursement due based upon Medicare, Medicaid and CHAMPUS Regulations. • Prepare monthly calculations and journal entries to properly maintain contractual allowance and related settlement accounts, for assigned facilities. Maintain current, correct account analysis related to program Income Statement and Balance Sheet accounts. Ensure monthly reports are prepared timely and accurately by supporting departmental Associates.• Coordinate with all regional, the Medicare field audits, provide complete, proper and timely information, and review audit adjustments prior to issuance of the Notice of Program Reimbursement, for assigned facilities. • Review prior year cost reports for any items requiring reopenings or appeals.• Monitor interim payment rates to ensure proper interim rates are maintained • Identify and pursue opportunities for maximization of reimbursement and review all reimbursement due based upon Medicare and Medicaid regulations• Serves as contact to assist outside consultants and/or Regional Leadership in preparation of reopening and appeal requests.

Completing cost report acceptance validation and issuing tentative settlements to providers. * Performing analytical reviews of the accepted cost reports and completing the desk review or preparing an audit scope for an on-site audit as well as preparing an audit engagement letter.* Designing audit tests, conducting audit entrance conferences with the provider, analyzing audit test results, preparing documented working papers, developing audit conclusions and preparing audit adjustments. * Conducting pre-exit and formal exit meetings with providers, preparing final audit reports and communicating final audit results to providers.* Performing supervisory reviews of desk reviews completed by other auditors, including providing supervisory review notes and guidance on the completion of the review. * Completing reopening requests sent in by providers who have evidence proving that the initial audit determination was incorrect. * Assisting in the completion of position papers relating to appeals to be heard before the Provider Reimbursement Review Board. * Obtaining a minimum of 80 hours of Continuing Education and Training on a bi-annual basis, of which a minimum of 20 hours must be Medicare related. * Participating in special projects at the requests of Novitas-Solutions Senior Management, Corporate Senior Management or the Centers for Medicare and Medicaid Services. * Assisting in the training and development of less experienced auditors.

Assists in plan preparation, performs, and/or participates in scheduled audits, follow-up audits, and special projects, as assigned. Review and evaluate the adequacy and effectiveness of internal control systems by completing a system flow analysis and performing transaction reviews. Evaluate documentation in accordance with state, federal, and institutional guidelines.Gathers sufficient, reliable, relevant, and useful information to support findings, conclusions, and recommendations.Maintains alertness for potential fraud and informs Director of Internal Audit immediately of any concerns.Participates in the development of the annual Internal Audit Risk Analysis. Communicates the progress of all audit projects to the Director of Internal Audit and report any deviations from established policy, procedure, or protocol.

Completed compliance reviews of the company’s Accounting and Sales/Marketing departmentsEnsured that the company was in compliance with the various states’ Department of Insurance.Reviewed Market Conduct Surveys and sought opportunities to enhance the company’s marketability as well as compliance.

Ensured compliance with Government Auditing Standards and quality performance requirementsAssigned field audits, coordinated audit activities, and review audit adjustments and final audit resultsHired, trained and directed Field Office staff, managed budget, controlled expensesCoached Audit Supervisors to promote positive leadership and an effective and collaborative working environmentSupervised on-site audits of providers' financial and statistical records assuring compliance with Government Auditing Standards and contract quality performance requirementsAdvised Medicare providers on interpretation of regulations, cost reporting procedures and provider reimbursement issues

Conduct pre-audits, desk reviews, and field audit programs applying judgment to determine the necessity for, and scope of, on-site auditsPrepare audit adjustment reports and the maintain detailed work papers in accordance with Government Auditing StandardsAnalyze expense data for reasonableness and allowability, and examine statistical data which form the basis for allocation of costsAnalyze and document the judgment applied to identify changes and trends in costs which form a basis for the selection of areas requiring detailed analysis and audit