Auditor II

This is a temporary position and there are no leave or retirement benefits offered with this position. Temporary employees who work an annual average of 30 or more hours per week may be eligible for health insurance coverage under the High Deductible Health Plan (HDHP). For more information on health benefits offered visit www.shpnc.org.

NOTE: If you are a current NC State Government employee, you will be considered for a temporary assignment. However, Temporary Solutions cannot accommodate dual employment.

This position has been reposted. Previous applicants must reapply to be considered.  

This temporary position is located in Raleigh, NC - Wake County.

TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position.

The Division of Health Benefits requires temporary workers with an approved hybrid telework schedule to work onsite at their assigned duty station at least 8 working days per month. More information on this arrangement may be obtained at the time of the interview.

Hourly Rate: $21.00 to $30.00

(Hourly Rates are based on education, experience, equity, and budget)

Position Overview:

NC Medicaid strives to optimize the purchasing power of each state dollar in the quest to "buy health" efficiently for Medicaid beneficiaries. Division of Health Benefits' Finance Section analyzes national and state economic trends, changes in the health care market, and trends in Medicaid spending using proven budget and finance practices to prepare the Department and North Carolina for financial challenges that lie ahead. The Provider Audit section examines annual NC Medicaid cost reports submitted by a variety of providers, including hospitals, long-term care facilities, federally qualified health centers, rural health clinics, local health departments, local education agencies, ambulance services, and state-owned and -operated institutions. This team also manages the issuance of cost settlements and hospital supplemental payments.

The primary purpose of this position is to serve as an auditor, to plan and conduct desk review, settlement, data analysis, and reconciliation activities on annual Medicaid and NC Health Choice cost reports including, but not limited to, Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Children's Developmental Service Agencies (CDSAs). This position will verify both accuracy of cost report data and/or ensure compliance with federal and state regulations, N.C. State Plan, Provider Participation Agreements, and the Medicaid Managed Care 1115 Waiver and Contracts.

Job Specific Responsibilities:

•    Plan and conduct desk review, settlement, data analysis, and reconciliation activities on annual Medicaid cost reports including, but not limited to Local Health Departments (LHDs), Children's Developmental Service Agencies (CDSAs), Public Ambulance Providers (PAPs), Local Education Agencies (LEAs), and State-owned Schools of Dentistry (SoSOD).

•    Verify both accuracy of cost report data and/or ensure compliance with federal and state regulations, N.C. State Plan, Provider Participation Agreements, and the Medicaid Managed Care 1115 Waiver and Contracts.

•    Assure provider has furnished all required supporting documentation.

•    Using assigned audit programs, plan and perform timely desk audits on the cost report to assure compliance with applicable state and federal regulations.

•    Generate audit adjustments and recommendations for the providers in accordance with state and federal regulations as well as GAAP and GAAS.

•    Prepare completed audit package for review by Audit Manager including all adjustments as necessary in cost reporting software packages.

•    Refer any suspected fraud or abuse issues found during the course of desk reviews or field audit to the Medicaid Program Integrity Unit.

•    Be assigned cases in which providers have appealed historical audit adjustments made by the Division to an annual Medicaid cost report. The auditor shall work to resolve the appeal if possible and defend adjustments through the various levels of appeal. This includes researching each appealed adjustment and all applicable background information and work papers, preparing a narrative to support / defend the adjustment and presenting the case with the Audit Manager at Reconsideration Review and Office of Administrative Hearings.

•    Responsible for responding to technical questions from providers, internal and external staff, and auditors reviewing DHB audit records.To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:

•     Proven ability in establishing and maintaining effective working relationships with internal and external stakeholders.

•     Ability to communicate clearly and professionally in oral and written form with internal and external stakeholders.

•     Demonstrated initiative and proven ability to act independently and exercise judgment to produce results, frequently under time constraints.

•     Ability to understand and evaluate cost reporting, cost allocation, and sampling techniques and methodology.

•     Working knowledge of Generally Accepted Accounting Principles (GAAP) and Generally Accepted Auditing Standards (GAAS).

•     Proven ability to accurately analyze and reconcile complex financial and cost reporting data.

•     Ability to understand, interpret, and apply complex State and Federal regulations regarding Medicare / Medicaid reimbursement and cost reporting.

•     Proven ability to identify, thoroughly research, and solve substantive issues with logic and reasoning including reporting of results.

•     Ability to educate relevant parties regarding programs and procedures.

•    Proven proficiency in Microsoft Office with intermediate to advanced skills in Excel and Word.

Management Preferences:

•     Knowledge of Medicare and/or Medicaid cost reporting forms and Medicaid/Medicare programs and cost reimbursement principles.

•     One or more years of audit experience in public accounting.

•    Certification/licensure as a certified public accountant, certified internal auditor, certified fraud examiner or related certification or licensure.

Some state job postings say you can qualify by an "equivalent combination of education and experience." If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See oshr.nc.gov/experience-guide for details.

Bachelor's degree in accounting from an appropriately accredited institution and two (2) years of accounting/auditing

experience in the preparation of interpretive or analytical accounting/financial statements and reports; or

Bachelor's degree in business administration or other field from an appropriately accredited institution with twelve

(12) semester hours in accounting and two (2) years of experience as specified above; or

Associate's degree in accounting from an appropriately accredited institution and four (4) years of experience as

specified above; or equivalent combination of education and experience.

Degrees must be from appropriately accredited colleges or universities.

The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.

Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment.

Pre-Employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).

Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. You will either receive a call to schedule an interview or an email notifying you when the job has been filled.

For technical issues with your application, please call the NeoGov Help Line at 855-524-5627. Applicants will be communicated with via email only for updates on the status of their application. If there are any questions about this posting other than your application status, please contact us at Medicaid.Recruitment@dhhs.nc.gov.