Provider Audit and Reimbursement - Lead Auditor (CMS)
Company: ARC Group
Location: Jacksonville
Posted on: February 13, 2026
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Job Description:
Job Description Job Description PROVIDER AUDIT AND REIMBURSEMENT
LEAD AUDITOR (CMS) - REMOTE ARC Group has an immediate opportunity
for a Provider Audit and Reimbursement Lead Auditor (CMS)! 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 Lead utilizes advanced knowledge of
Medicare laws, regulations, instructions from the Centers for
Medicare and Medicaid Services (CMS), and provider policies to
perform desk reviews and audits of the annual Medicare cost
reports, as well as interim rate review/reimbursement, and/or
settlement acceptance/finalization for all provider types,
including complex and organ transplant hospitals, as both a
preparer and reviewer of work product based on established
performance goals. The position will mentor and train Auditors and
In-Charge Auditors and oversee daily workload of unit team.
ESSENTIAL DUTIES & RESPONSIBILITIES Lead Accountabilities (60%):
Coordinates with management by overseeing the unit's daily
workload. Routinely uses independent judgment and discretion to
make decisions for self and less experienced auditors with regard
to additional time and procedures; identifies and raises errors to
the attention of supervisor and/or provider and identifies and
communicates actions to correct same. Prioritizes auditor work and
ensures that audit work is completed on time. Recognizes data needs
for self and other auditors; develops plan of work for less
experienced auditors (10%) Analyzes working papers and cost reports
for errors. (10%) Reviews workpapers of auditors for correctness,
control and adherence to Generally Accepted Accounting Practices
(GAAP), Generally Accepted Accounting Standards (GAAS) and
Government Auditing Standards (GAS) as required. Examines and
reviews workpapers upon completion of the audit to ensure
compliance with CMS Uniform Desk Review (UDR), policy, or technical
direction and reflects proper reference, clear and concise
conclusion of the major audit categories and assembly of working
papers into logical sequence. (10%) Reviews, evaluates and approves
the disbursement of tentative cost settlements in compliance with
Federal and State Government regulations for each class/type of
provider within area of responsibility. (5%) Develops technical
competence and constructive work attitudes in self and less
experienced auditors; strives to build an effective team and to
develop the growth needs of individual members of his/her team.
(10%) Coordinates the assignments and subsequent development of
auditors based on their training needs; explains work to be
performed and principle or objective of procedure; provides
accurate and constructive coaching, mentoring, and training of team
members. Identifies training needs within the team and/or
department. (5%) Manages, implements and coordinates an internal
quality control program in conjunction with the Internal Quality
Control (IQC) department and provides reasonable assurance that the
Provider Audit and Reimbursement Department has established, as
well as is following, adequate policies, procedures, and is
following applicable auditing standards. (5%) Facilitates the
development of Quality Management System (QMS) policies and
procedures. (5%) Auditor Accountabilities (40%) Performs audit
functions including those which are non-routine; keeps track of
instructions for many projects simultaneously. Presents and defends
adjustments and workpapers to provider with minimal consultation
from manager. (10%) Coordinates large audits and/ or diverse audits
independently while seeking help on truly unusual or major items.
(10%) Uses professional communication techniques in own and
auditor's work and in conclusions drawn from the work. (5%)
Establishes and maintains constructive provider relations by
demonstrating a professional approach, expressing positive
corporate image. Advises providers on Medicare policy questions and
directs other questions to responsible departments or personnel.
(5%) Conducts entrance and exit conferences and meetings away from
office as needed. (5%) Perform other duties as the manager may deem
necessary (5%) REQUIRED QUALIFICATIONS Bachelors' degree or a
combination of education and experience in disciplines such as
auditing, accounting, analytics, finance or similar experience in
lieu of a degree In addition to having a thorough understanding of
the Medicare cost report, including the step-down method, the
candidate must possess the required work experience to
independently perform the duties of the position. To demonstrate
the necessary experience, the candidate must have performed the
following tasks at a sufficiently successful level to show
understanding of the work, judgment, and the ability to perform
these tasks independent of supervision, which is generally gained
through 2.5 to 3 years of Medicare cost report auditing experience:
A Uniform Desk Review (UDR) and an audit for a large or complex
hospital, as the in-charge auditor A review of Medicare Bad Debts,
inclusive of all relevant sample selection and testing according to
CMS standards A review of DSH, inclusive of all relevant sample
selection and testing according to CMS standards A review of
IME/GME, inclusive of reviewing rotation schedules, bed count and
all relevant testing according to CMS standards A review and
appropriate approval of an audit's scope A supervisory review and
approval of all work papers* Sample testing, transferring of
testing to the audit adjustment report, and explaining the
adjustments to a provider with the achievement of understanding by
the provider* Assistance to audit management in the assignment and
monitoring of workload, as well as leading junior team members
Additionally: The auditor must display leadership skills by being
integrally involved in junior auditor formal training or assisting
on special projects, or have been a Subject Matter Expert (SME)*
The auditor must be able to prepare workpapers according to CMS
standards The auditor must have a good working knowledge of all
applicable software applications The auditor must be able to serve
as an effective mentor for less experienced staff The auditor must
demonstrate engagement, commitment to departmental success, and
professionalism by completing their work within prescribed
deadlines, taking ownership of their work and setting an example
for more junior auditors and staff by consistently and reliably
working the time necessary to properly complete their duties,
timely attending meetings, providing adequate notice to management
and co-workers when unexpected issues arise, and ensuring work is
properly covered in the auditor's absence. Demonstrated oral and
written communications skills Demonstrated ability to exercise
independent judgement and discretionDemonstrated attention to
detail PREFERRED QUALIFICATIONS 3 to 4 years of Medicare cost
report auditing experience Demonstrated work experience to
independently perform: A review of Nursing & Allied Health
Education (NAHE), inclusive of calculating the additional add-on
payment and all relevant testing A review of Organ Acquisition
costs, inclusive of all relevant testing Requirements This
opportunity is open to remote work in the following approved
states: AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH,
PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within
these states may require further approval. In FL and PA in-office
and hybrid work may also be available. Would you like to know more
about our new opportunity? For immediate consideration, please send
your resume directly to John Burke johnb@arcgonline.com or apply
online while viewing all of our open positions at
www.arcgonline.com. ARC Group is a Forbes-ranked a top 20
recruiting and executive search firm working with clients
nationwide to recruit the highest quality technical resources. We
have achieved this by understanding both our candidate's and
client's needs and goals and serving both with integrity and a
shared desire to succeed. At ARC Group, we are committed to
providing equal employment opportunities and fostering an inclusive
work environment. We encourage applications from all qualified
individuals regardless of race, ethnicity, religion, gender
identity, sexual orientation, age, disability, or any other
protected status. If you require accommodations during the
recruitment process, please let us know. Position is offered with
no fee to candidate.
Keywords: ARC Group, Valdosta , Provider Audit and Reimbursement - Lead Auditor (CMS), Accounting, Auditing , Jacksonville, Georgia
