MEDICAID REIMBURSEMENT AUDIT SUPERVISOR 23505

5/2/88 A

CLASS CONCEPT/FUNCTION

This class is the supervisory 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 developing and supervising the operation of audits of institutional health care organizations. This class is distinguished from the Reimbursement Audit Manager by its focus on issues related to the daily operations of audit programs. It is distinguished from the Medicaid Reimbursement Senior Auditor by the responsibility of supervising audit teams rather than focusing on actual auditing of institutional health care providers.

DISTINGUISHING FEATURES OF THE WORK

Complexity of Work: Performs work of considerable difficulty. Guides staff in responding to controversial issues regarding the audit and financial analysis of health care institutions. Determines areas of concentration and methods of approach for auditing institutional health care providers. Monitors and coordinates the Commonwealth's documentation of the audit appeal issues. Evaluates the financial impact of reimbursement program changes to institutional providers. Tests completed audits for compliance with audit standards, reimbursement principles, and applicable laws/regulations. Evaluates audit progress and schedules interim deadlines. Coordinates and monitors staff training.

Supervision Given: Provides directions to Medicaid Reimbursement Auditors and Senior Auditors as well as Medicaid Personal Funds Auditors, or provides general direction to Medicaid Reimbursement Analysts.

Supervision Received: General direction is received from a Medicaid Reimbursement Audit Manager. Completed work is reviewed in terms of accomplishing financial analysis and audit objectives.

Scope: Work affects the financial operation of institutional health care organizations, of Medicaid program, and the services received by patients.

Impact of Actions: Effective supervision of audits ensures proper payment and reimbursement for expenses. Ineffective decisions could result in misuse of time, money and personnel resources.

Personal Contacts: Frequent internal and external contact with agency personnel, health care provider representatives (health care administrators, attorneys and certified public accountants) and the Attorney General's staff regarding audit findings and health care laws and regulations.

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. Some knowledge of federal and state laws, regulations and regulatory practices affecting institutional health care financing.

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; and to lead professional subordinate auditors.

QUALIFICATIONS GUIDE*

Licenses or Certifications: 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 leading an auditing or accounting team.

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.