Provider Audit and Reimbursement Manager (CMS) - American Recruiting & Consulting Group : Job Details

PROVIDER AUDIT AND REIMBURSEMENT MANAGER (CMS) - REMOTE

ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Manager (CMS)! Must have experience with Medicare Cost Reports. This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential.

100% REMOTE!Candidates must currently have PERMANENT US work authorization.Job Description:

The Provider Audit and Reimbursement Manager is responsible for managing a team of auditors and ensuring the work is performed in compliance with Medicare laws and regulations, CMS standards, and company policies. The Manager will oversee either audit or reimbursement functions, including desk review/audit, reopenings/appeals, interim rate review/reimbursement, or acceptance/finalization for all provider types. Responsibilities include assigning workload, ensuring timely and accurate work, and making final reimbursement decisions.

Essential Duties & Responsibilities:

Manage team members and workload to ensure compliance with CMS standards, Medicare laws, regulations, and budgets. (20%)

Oversee daily activities of the Audit/Reimbursement unit, coordinate with other departments and external entities, and manage team locations. (20%)

Coordinate and manage service reimbursement, update interim rates, and ensure data accuracy in claims processing systems. (5%)

Test and validate pricing software releases. (5%)

Manage audits, assign work, and guide team members on audit issues. (5%)

Maintain audit and appeal assignments, schedule resources, and meet performance targets. (5%)

Ensure completion of objectives within quality, policy, regulation, and budget standards. Determine audit work plans. (5%)

Review workpapers for accuracy and compliance with GAAP, GAAS, GAS, and CMS standards. (5%)

Review and approve disbursements of tentative cost settlements. (5%)

Make accounting decisions related to audits, consulting with senior management as needed. (5%)

Review and approve completed audit reports. (5%)

Participate in entrance and exit conferences, assist auditors, and follow up on recommendations. Handle inquiries from agencies. (5%)

Research policies related to governmental regulations on cost settlements. (5%)

Attend meetings and assist providers with inquiries. (5%)

Required Qualifications:

• Bachelor's or Master's degree in Accounting or Finance, or other fields with 15+ credit hours in relevant courses.
• At least 4 years of Medicare audit and reimbursement experience, including 3 years in supervisory or project management roles.
• Strong communication skills, ability to exercise independent judgment, and attention to detail.

Preferred Qualifications:

• Masters in Business Administration (MBA)
• Certified Public Accountant (CPA)

This remote position is available in specific states, including AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Some locations may require additional approval. In-office or hybrid options may be available in FL and PA.

Interested in this opportunity? Send your resume to John Burke at [email protected] or apply online at www.arcgonline.com.

ARC Group is a top-ranked recruiting firm committed to diversity and inclusion. We offer equal employment opportunities and accommodations during the recruitment process.

Position is offered with no fee to candidates.

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