GENERAL STATEMENT OF DUTIES: To be responsible for conducting the more difficult and/or complex desk and field audits of the financial records of community based providers of services such as convalescent, nursing and rest homes, centers and services for individuals with substance use-related issues, and people with an intellectual and developmental disability to determine compliance with the provisions of the contract with the state and the established rates of reimbursement included therein and to identify any recoverable overpayments; to assist a superior in carrying out several of its assigned areas of responsibility; as required, to provide guidance and direction to rate analysts engaged in conducting routine audits; and to do related work as required.
SUPERVISION RECEIVED: Works under the general supervision of a superior with considerable latitude in the exercise of initiative and independent judgement; assignments are received in outline form and are reviewed upon completion through conferences and submitted reports for results obtained and conformance to laws, departmental policies, objectives, rules and regulations.
SUPERVISION EXERCISED: As assigned, may plan, supervise and review the work of a staff of professional and clerical subordinates.
- To be responsible for conducting the more difficult and/or complex desk and field audits of the financial records of community based providers of services such as convalescent, nursing and rest homes, centers and services for individuals with substance use-related issues, and people with an intellectual and developmental disability to determine compliance with the various provisions of the contract signed with the state and the established rates of reimbursement included therein for such services and to identify any recoverable overpayments as well as submit recommendations involving such rates of reimbursement under the contract and their projected applicability or modification under a renewal contract.
- To confer with provider representatives such as independent accountants, lawyers and employees to discuss questions on cost and financial reports submitted by providers' accountant/auditor, questions to lawyers on legal bills or services rendered by them, interviews with employees to verify allocation of administrative costs, conferences with providers and/or accountants regarding legitimacy of accepting specific items as legitimate cost expenditures, and other comparable questions or conferences designed to resolve problems of rate reimbursement.
- To review and analyze provider annual cost reports to determine reasonableness of costs for past periods and a basis of projected costs for any new contractual year.
- To assist a superior in carrying out several of its assigned cases of responsibility such as: projecting and establishing cost rates for new providers of services; providing assistance, as required, in setting up and maintaining financial and other cost oriented records in conformity with state guidelines and contractual agreements; participating in liaison and negotiator functions in the development of principles of reimbursement with various departmental program agencies by sitting down with divisional heads and discussing what will be accepted as legitimate cost expenditures for services provided; participating in the design and/or revision of various annual cost reporting forms and other budgetary documents; scheduling and participating in conferences with providers' fiscal representatives upon contract expiration to review results of the rate setting processes and in negotiating recoveries of any determined overpayments; and in collecting statistical and research data on provider costs and in developing such data for the purpose of preparing comparative studies for intra-departmental purposes. As required, to provide guidance and direction to rate analysts engaged in conducting routine and/or less complex audits of financial records of various providers of community-based services.
- To do related work as required.
KNOWLEDGE, SKILLS AND CAPACITIES: A thorough knowledge of the principles and practices of accounting and auditing and the ability to apply such knowledge in conducting audits of financial records of community based providers of services and in providing assistance and guidance to such providers in establishing and maintaining proper financial and other costs oriented records; a working knowledge of the functions and operations of community based providers of services such as convalescent, nursing and rest homes, centers and services for individuals with substance use-related issues, and people with an intellectual and developmental disability; a working knowledge of the laws, rules and regulations governing per diem rates paid to community based homes, centers and services for patient and client care and treatment and the ability to apply such knowledge in establishing appropriate principles of reimbursement, funding principles and rate schedules; the ability to assist a superior in projecting and establishing cost rates, collecting statistical and research data on patient and client care costs, and preparing comparative studies and analyses, projected costs of departmental programs, and rate schedule adjustments; the ability to establish and maintain effective working relationships with superiors, providers of community based services and/or their representatives and their employees; the ability to provide guidance, direction and supervision to rate analysts; and related capacities and abilities.
EDUCATION AND EXPERIENCE:
Education: Such as may have been gained through: graduation from a college of recognized standing with specialization in accounting or business administration; and
Experience: Such as may have been gained through: employment in a responsible accounting or auditing position in a hospital, extended care facility, or centers for people with an intellectual and developmental disability including experience in a rate setting unit or involving rate analysis of patient care services.
Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.
Reconciliation of RIFANS transaction data to prepare cost schedule workpapers, allocations & cost centers for the processing of financial reports including but not limited to the Medicare cost report for Eleanor Slater Hospital and the annual cost report for RICLAS.
Development of journals to correct transaction data and/or charge other BHDDH divisions or state entities as needed Knowledge of Medicare Cost Report, Cost Allocations, Federal and State reimbursement principles are preferred.