Health Management Systems, Inc. Long Term Care Auditor I in Westerville, Ohio

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for a LTC Auditor I who is responsible for the identification and recovery of client improper payments made to long term care healthcare providers.

Essential Responsibilities:

  • Interpreting and applying federal and state Medicaid regulations, statutes, and policies pertaining to long term care.

  • Analyzing provider records from multiple accounting software programs.

  • Identifying improper payments relating to inaccurate payments, collections, and coordination of benefits.

  • Acting as the primary liaison with their assigned long term care providers.

  • Managing 40 audits in varying phases

  • Responsible for provider reporting and communication.

  • Responsible for status reporting to management.

Non-Essential Responsibilities:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Strong analytical skills and an ability to overcome obstacles and resolve problems.

  • Ability to function independently and effectively under pressure and deadline oriented project demands as well as manage multiple initiatives.

  • Ability to multi-task, establish priorities, and meet revenue objectives.

  • Must have excellent organizational and time management skills in order to manage multiple audits and meet or exceed revenue targets.

  • Must have exceptional written and oral communication and interpersonal skills in order to build strong working relationships with both internal staff and assigned LTC providers.

  • Must be able to follow directives and adapt to shifting priorities as required.

  • Working knowledge of HIPAA privacy and Security rules.

  • Professional, confident, and have a positive work attitude.

  • Ability to perform well in team environment, with staff at all levels, to achieve business goals.

  • Ability to maintain a professional demeanor and appearance at all time.

  • Proficiency in PC based business applications including Microsoft Office (Word, Excel, Power Point, and Access).

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 10% of time based on business needs

Minimum Education:

  • High School Diploma/GED required

  • Bachelor’s degree preferred

Minimum Related Work Experience:

  • Associates’ degree required

  • With Bachelor’s degree, no experience required

  • In lieu of Bachelor’s degree, 1 to 5 years’ experience required

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Title: Long Term Care Auditor I

Location: Ohio-Westerville

Requisition ID: 1800111X

EEO/Minorities/Females/Protected Veterans/Disabled.