22nd Century Technologies Inc. · 6 hours ago
Accounting Auditor(Healthcare)
Madison, WI
Contract
Onsite
Mid Level22nd Century Technologies Inc. is seeking an Accounting Auditor specializing in healthcare compliance. The role involves conducting audits of health care entities reimbursed by the Title XIX Wisconsin Medicaid Program, ensuring compliance with federal regulations, and monitoring contracts for Medicaid non-compliance.
Artificial Intelligence (AI)Cloud ComputingEnterprise ApplicationsGovernmentInformation ServicesInformation TechnologyInfrastructureIT Infrastructure
Hiring Manager
Shivam Sharma
Responsibilities
Conduct on-site and desk reviews of Rural Health Clinics (RHC) and, in rare occasions, Federally Qualified Health Centers (FQHC). Set reimbursement rates for RHC and FQHC providers, developing and using appropriate reimbursement methodology which reflects Medicaid policy and cost reports to determine the amount of reimbursement each RHC or FQHC is to receive for services provided to Medicaid recipients
When conducting RHC audits, verify encounter data, medical records, account details, cash receipts, and HMO detail; review provider's cost report expenses for RHC's with fewer than 50 beds; calculate the encounter rate using either the Trial Balance and Medicare Cost Report, Prospective Payment System (PPS) rate, or Medicare Upper Payment Limit, and add the Health Care Professional Shortage Area (HPSA) bonus (as appropriate); and make adjustments to submitted cost reports to determine if there is an amount owed to/from the RHC
When conducting FQHC audits, verify reported costs; encounters; revenues from Medicaid fee for service (FFS) and HMOs, Medicare, Medicaid recipient copayments, and other third parties; and make adjustments to submitted cost reports to determine if there is an amount owed to/from the FQHC
If a provider submits an interim report, verify the information submitted on the cost report. Complete a financial transaction form and enter the information into PRISM. Write a letter to be mailed to the provider informing them of their interim payment amount
Research the body of federal and state Medicaid statutes, codes, and other pertinent regulations and laws to determine and interpret legal provisions and guidelines which apply to the provider subject to audit and identify pertinent audit and investigative issues. Write-up each legal question identified that relates to the statutes, administrative codes, or regulations to be enforced in an audit or investigation and assist the assigned Client Office of Legal Counsel in the formulation of the Office of the Inspector General (OIG) position on the legal questions posed
Develop routine and customized audit working papers and audit instruments, and establish formal or informal field audit format to be used in auditing provider. Analyze federal and state transmittals and update audit programs in concurrence with accepted audit standards and practices, for adherence to both state and federal statutes and regulations
Schedule audit with entity to be audited
Conduct entrance and exit conferences with audited entity to explain the nature and scope of the audit, the audit process, and findings
Independently and as a team member review medical records, trial balances, patient accounts, bank records, vouchers, independent audit reports, bridging worksheets, personnel and or payroll records, remittances, patient charts and other documentation to support reported items on the cost reports, to determine federal and state guidelines are being followed by provider and document findings
Qualification
Required
A Bachelor's Degree in accounting OR professional training in accounting or auditing such as that which would be acquired by earning a Bachelor's Degree in accounting or auditing from an accredited post-secondary college/university; or commensurate experience and training
Knowledge of modern accounting and auditing theory and practices as used in complex and comprehensive audits
Knowledge of Generally Accepted Accounting Principles (GAAP) and Generally Accepted Auditing Principles and Standards and the ability to perform audits of the various health care entities
Knowledge of program, financial, and accounting systems and procedures used by the various health care entities to manage the business of the entity such as how health care providers keep patient accounts showing charges and payments and how billing clerks prepare claims for reimbursement from third party payors and the specialized governmental or industry accounting and auditing standards or audit guides used to audit the provider
Knowledge of the internal operating procedures and controls that the various health care entities need to follow to assure the appropriate handling and reporting of money in their accounting system including knowledge of computerized accounting and billing systems
Knowledge of the various health care services and providers such as physicians, medical specialties, dentists, therapies (occupational, physical, speech) vision care, mental health (psychotherapy, AODA, day treatment, case management, community support), nursing home, hospital, chiropractor, pharmacies, and specialized medical vehicles, etc., participating in the Wisconsin Medicaid Program
Company
22nd Century Technologies Inc.
22nd Century Technologies is an IT Systems Integrator, Software Products and Consulting Company
Founded in 1997
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Anil Sharma
Chief Executive Officer
Recent News
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