MEDICAID REIMBURSEMENT AUDITOR 23502

5/2/88 B

CLASS CONCEPT/FUNCTION

This class is the first and journey level in a series of classes for positions responsible for auditing the financial operations, financial condition and regulatory compliance of institutional providers of health care. This class is responsible for reconciling, evaluating and auditing expenses related to patient care accounts and charges of institutional health care providers. This class is distinguished from the Medicaid Reimbursement Senior Auditor class by the latter's additional responsibility of leading the work of others.

DISTINGUISHING FEATURES OF THE WORK

Complexity of Work: Performs work of moderate difficulty. Reconciles general ledger balances to expense accounts for separate cost centers. Traces expenses to books of original entry and evaluates their relationship to necessary and reasonable patient care. Tests interest expenses for accuracy of calculation and allowability under Health Care Financing Administration (HCFA) regulations. Verifies property of claimed depreciation expenses. Tests income accounts and patient stay records. Explains and documents audit adjustments.

Supervision Given: Supervision is typically not a factor.

Supervision Received: Receives general supervision from a Medicaid Reimbursement Audit Supervisor.

Scope: Responsibility exists for performing audits of institutional health care providers throughout the state.

Impact of Actions: Decisions affect the financing of health care for the medically indigent in nursing homes, hospitals and other health care institutions. Effective performance of audits will reduce potential account errors and costs in terms of money and time.

Personal Contacts: Frequent internal and external contacts with agency personnel and representatives of health care institutions at entrance conferences, exit conferences and during on-site audits to discuss audit purposes and findings.

KNOWLEDGES, SKILLS AND ABILITIES:

Knowledge: Working knowledge of principles and technical methods of professional auditing and of the financial analysis of business organizations. Knowledge of business accounting practices, and of regulatory compliance processes.

Skills: None identified for this class.

Abilities: Demonstrated ability to assess complex financial analysis and audit issues; to accomplish audit program objectives; to interpret complex statutes and regulations, General Accepted Accounting Principles and Generally Accepted Auditing Standards.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from an accredited college or university with course work in accounting, finance or a related field.

Level and Type of Experience: Experience in auditing or accounting.

An equivalent combination of training and experience indicating possession of the preceding knowledge and abilities may substitute for this education and experience.

CLASS HISTORY

This is a new class established in September, 1986.