Audits Manager I / 60015133 RP

Are you the One? We are looking for an Audits Manager I, who will, under general supervision, plans, implements, administers, and directs special projects and programs relating to programmatic reimbursement of hospitals (including the SC Medicaid DSH Program) and non-institutional Medicaid providers.  Supervises the rate setting/payment functions of hospitals and non-institutional providers participating in Medicaid. Reviews annual Administrative and Medicaid Program service contracts in order to validate allowable costs of program budgets, validate appropriate funding sources, and validate cost report/contract expenditure requirements.

• Performs fundamental supervisory and leadership functions in accordance with Department policies and procedures, best practices and Federal and State rules and regulations, especially with regard to Equal Employment Opportunity Commission (EEOC) standards.  Maintains an effective organizational team and motivates diverse staff to accomplish mission critical operations and objectives. Promotes workforce engagement.
• Oversees the desk review and rate setting process of hospitals and non-institutional Medicaid provider cost reports to ensure compliance with CMS approved state plan reimbursement methodologies. Prepares settlement reviews for those state plan services requiring retrospective cost settlements or Certified Public Expenditure (CPE) reviews. Determines annual SC Medicaid DSH payments.
• Oversees the desk review and rate setting process of hospitals and non-institutional Medicaid provider cost reports to ensure compliance with CMS approved state plan reimbursement methodologies. Prepares settlement reviews for those state plan services requiring retrospective cost settlements or Certified Public Expenditure (CPE) reviews. Determines annual SC Medicaid DSH payments.
• Oversees the calculation of the quarterly WRAP payment process for MCO contracting Federally Qualified Health Centers and Rural Health Clinics (to include quarterly dental service WRAPS) to ensure compliance with federal regulations. Oversees the calculation of the change in scope rate requests for FQHCs to ensure compliance with CMS approved state plan payment methodology.
• Reviews budgets of Medicaid administrative contracts to ensure that costs/projects reported are allowable for Medicaid administrative claiming purposes. Reviews certain Medicaid service provider contracts to ensure that correct rates are reflected, validate cost report requirements (if required), as well as validate the contract language relating to the source/responsibility of the state matching funds.
• Performs other related duties as assigned, which would include assisting the Bureau Chief for Reimbursements in the development and review of alternative reimbursement methodologies applicable to ancillary/non-institutional Medicaid providers that may result in the submission of state plan amendments to CMS. It will also include other duties as assigned including any updates/creation of current/new SAS reports.

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

A bachelor's degree in accounting or finance and experience in professional-level accounting, auditing or financial management. 

An equivalent combination of education and experience may be accepted with prior State Human Resources approval.

All degrees must be from a college or higher education institution recognized by the US Department of Education & Council for Higher Education Accreditation (CHEA).

Additional Requirements:

• Occasional overnight travel.
• Requires holder to drive routinely.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
  
  
  

• Thorough knowledge of Medicaid and Federal and State laws and regulations.
• Thorough knowledge of complex rate setting and reimbursement methodologies for hospitals and non-institutional providers.  
• Thorough knowledge of principles, policy, planning and development of assigned Medicaid programs.  
• Thorough knowledge of the principles, theories and practices of accounting, auditing, budgeting, and financial management.  
• Ability to establish and maintain effective working relationships with provider associations/agencies.

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

Salary : $56,210 - $104,000