MEDICAID REIMBURSEMENT SENIOR AUDITOR 23504

5/2/88 B

CLASS CONCEPT/FUNCTION

This class is the advanced 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 auditing institutional health care organizations throughout the state. This class is distinguished from the Medicaid Reimbursement Auditor class by the responsibility of functioning as lead auditor of a field audit team. This class is distinguished from the Medicaid Reimbursement Audit Supervisor class which has total supervisory responsibilities.

DISTINGUISHING FEATURES OF THE WORK

Complexity of Work: Performs work of considerable difficulty. Schedules, performs and supervises the audit of financial statements, ledgers, journals, contracts, patient files, payroll records, new construction plans, debt financing documents and statistical reports. Identifies recordkeeping discrepancies and internal accounting control problems and evaluates written action plans to correct these problems. Authorizes expansion of detailed audit reviews based upon materiality of potential adjustments. Conducts entrance and exit conferences to explain the purpose and adjustments of audits. Responds to health care providers' theories and alternatives regarding adjustments. Proposes final audit adjustment reports and revised cost reports. Prepares position papers for audit appeals and represents the Commonwealth at appeal and court hearings. Acts as lead auditor of audit teams.

Supervision Given: Supervision is typically not a factor; however, positions may schedule, assign, and review the daily activities of one or more Medicaid Reimbursement Auditors.

Supervision Received: Receives directions from a Medicaid Reimbursement Audit Supervisor. Completed work is reviewed in terms of completing audit team objectives.

Scope: Responsibility exists for leading an audit team in audits of institutional health care organizations 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 leadership of audit teams will promote efficient use of time, money and resources and accurate audit results.

Personal Contacts: Frequent internal and external contact with agency personnel, health care providers' representatives (administrators, financial officers and contract auditors) and the Attorney General's staff to discuss audit findings and audit appeal issues, and to respond to questions regarding audit issues.

KNOWLEDGE, SKILLS AND ABILITIES

Knowledge: Considerable knowledge of principles and technical methods of professional auditing and of the financial analysis of business organizations. Considerable knowledge of business accounting practices. Knowledge 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, Generally Accepted Accounting Principles and Generally Accepted Auditing Standards.

QUALIFICATIONS GUIDE*

Licenses or Certifications: None.

Education or Training: Graduation from an accredited college or university with major 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.