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Years of Experience
Date Last Verified
Paralegal The candidate will be responsible for completing limited and full desk reviews on providers as assigned. Primary duties may include: Performs audit work scoped by the desk reviews and will be the in-charge auditor on small and less complex audits. Assists higher level auditor on field work and appeals as assigned. Responsible for completing interim rate reviews, tentative settlements and final settlements of providers as assigned. Performs special audits of End Stage Renal Disease (ESRD) providers and provider exception requests as assigned. Updates STAR, FISS and PSF as assigned. Participates as a team member on audits of provider's records and other projects. Analyzes and interprets data and makes recommendations for change based on their judgment and experience. May perform Part A provider enrollment responsibilities as needed. Must be able to perform all duties of lower level positions as directed by management.
Qualification and Experience
The candidate should have Paralegal degree or certification. Requires a BA/BS degree, preferably in accounting; 2-5 years of audit/reimbursement or related Medicare experience; thorough knowledge of CMS program regulations and cost report format; knowledge of CMS computer systems and Microsoft Office Word and Excel; or any combination of education and experience, which would provide an equivalent background. MBA, CPA or CIA preferred. Must obtain Continuing Education Training requirements (where required). Cost of care report Appeals experience preferred.
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