PARD Settlement Associate 1 - remote

Get To Know Us!

Guidewell and its family of forward-thinking companies are focused on helping people and communities achieve better health and are at the forefront in the transformation of health care.

Novitas Solutions, Inc., a GuideWell Company, provides high-quality, innovative, administrative services for government-sponsored healthcare programs.

What We Can Offer YOU!

We offer competitive salaries and benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise!

In this role you would gain valuable leadership experience that will help you to continue to grow in your career!

What Will Be Your Purpose:
The Provider Audit and Reimbursement Settlement Associate position's primary role is to process the acceptability of annual Medicare cost reports and to accurately and timely process final settlement of less complex healthcare providers (non-hospitals).

What Will You Be Doing:

• Process Cost Report Settlement of less complex healthcare providers including Skilled Nursing Facilities (SNF), End Stage Renal Disease (ESRD), Community Mental Health Clinics (CMHC), Rural Health Clinics (RHC) and Home Office cost statements submitted by Audit by utilizing HFS, a CMS-approved software program. After a thorough review of all edits and results, the final product is the issuance of the Notice of amount of Program Reimbursement letter and adjusted cost report print out which indicates the final balance due. This information is forwarded to Accounts Receivable for disbursement or collection and it is also transmitted electronically to CMS.
• Process Cost Report Acceptance of less complex healthcare providers including SNF, ESRD, CMHC, RHC and Home Office cost statements which includes acceptance or rejection. Staff has the ability to determine rejections but must be approved by Team Lead or above.
• Compile and maintain data logs, processing incoming and outgoing mail, scanning functions, report compilation, data preparation, as well as record filing and retrieval.
• Resolve discrepancies and may communicate with a variety of administrative and professional employees within and outside the organization.
• Review and interpret cost reporting instructions, CMS instructions and any Technical Direction Letter (TDLs) issued by CMS to make an informed decision on any discrepancies. Must get high level staff approval.
• Meet quality and production standards established by management.
• Perform other duties as the supervisor may, from time to time, deem necessary.

To perform this job successfully, you must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

What You Must Have:

• High School Diploma or GED
• 2 years' related work experience including general accounting or Medicare reimbursement
• PC skills working with Windows.

Nice Have:

• Associate Degree in Accounting
• Basic understanding of reimbursement methodologies and Medicare cost report flow.

"We are an Equal Opportunity Employer/Protected Veteran/Disabled"

The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.