Palmetto GBA

Auditor

• Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls.
• Identifies, documents, and evaluates business risks.
• Documents issues, the causes of those issues, and their effects on the process/function and the corporation.
• Drafts recommendations to limit risks and improve processes, functions and activities.
• Writes audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions, and recommendations.
• Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies.
• Conducts testing of corrective actions as identified.
• Develops detailed reports on each audit conducted.
• Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes.
• Examines and evaluates financial and information systems, recommending controls to ensure system reliability and data integrity.
• Conducts special audit studies for management, such as those required to discover controls for prevention of fraud.
• Prepares reports of findings and recommendations for management.
• Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel.

Auditor II – Medicare Cost Reporting

• Conduct internal and/or external timely operational, financial, and/or compliance audits
• Identify, document, and evaluate business risks
• Develop written audit programs
• Conduct testing and analysis of existing controls to determine adequacy and effectiveness
• Prepare written work papers to document testing results
• Document issues, their causes, and effects on the corporation
• Serve as Lead Auditor on more complex assignments
• Draft recommendations to limit risks and improve processes
• Write audit reports for corporate executive management
• Collect and analyze data to detect deficiencies
• Conduct special audit studies for management
• Provide training to other auditors to maximize efficiency

Auditor III, Medicare

Accounting Manager

• Prepares various financial data associated with refunds, invoices, recoupments, adjustments, cash disbursements, deposits, check voids and reissues, disputes, correspondence, or other data in support of the finance or accounting function.
• Ensures data is complete, accurate, and organized for processing.
• Provides supervisor with daily, weekly, and/or monthly summary reports of accounting activities for the position.
• Completes moderately difficult research using financial reporting systems, files, and other means to identify errors such as overpayments or misapplication of funds.
• Resolves routine questions and problems, referring complex issues to higher levels.
• Performs calculations on financial documents to ensure accuracy of bank deposits, receipts, disbursements, refunds, or other accounting-related items.
• Provides other support duties related to the accounting/finance function that may include monitoring financial systems, keying journal entries, tracking funds, balancing accounts, maintaining inventory and receiving cash funds from customers, etc.
• May assists less experienced accounting clerks as needed.
• Determines, prepares, and distributes correspondence regarding monies due or erroneously received.
• Issues refunds as appropriate.

Accounting Technician II, Medicare

• Conducts internal and/or external audits
• Identifies, documents, and evaluates business risks
• Develops written audit programs
• Conducts testing and analysis of existing controls
• Prepares written work papers to document testing results
• Serves as Lead Auditor on complex audit assignments
• Writes audit reports for corporate management
• Collects and analyzes data to detect deficiencies
• Provides training to other auditors

Auditor III

Claims Specialist

• Reviews and adjudicates complex or specialty claims
• Determines whether to return, deny or pay claims following organizational policies and procedures
• Assists in training or mentoring new staff members
• Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes
• Verifies that claims have been keyed correctly
• Ensures that claims are processing according to established quality and production standards
• Corrects processing errors by reprocessing, adjusting, and/or recouping claims
• Researches and resolves claims edits and deferrals
• Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas
• Responds to routine correspondence and completes spreadsheet if applicable

Claims Processor II

• Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls
• Identifies, documents, and evaluates business risks
• Documents issues, the causes of those issues, and their effects on the process/function and the corporation
• Drafts recommendations to limit risks and improve processes, functions and activities
• Writes audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions, and recommendations
• Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies
• Conducts testing of corrective actions as identified
• Develops detailed reports on each audit conducted
• Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes
• Examines and evaluates financial and information systems, recommending controls to ensure system reliability and data integrity
• Conducts special audit studies for management, such as those required to discover controls for prevention of fraud
• Prepares reports of findings and recommendations for management
• Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel

Auditor II – Medicare Cost Reporting

Auditor III, Medicare

Accounting Technician II, Medicare

Auditor III

Claims Processor II

Medicare Cost Reporting Auditor II