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Opportunity Snapshot

For the experienced healthcare auditor, the timing is impeccable to join HMS, the undisputed industry leader in coordination of benefits and program integrity services for government healthcare programs. In the current economic climate, there is a strong emphasis among policy leaders on cost containment and payment accuracy and with Medicaid spending projected to double in ten years, we are uniquely poised to capitalize on this billion dollar market.

Joining our newly created Medical Review Documentation Audit department, you will not only shape this role moving forward but also expand your competencies as you manage a variety of desk and field-based audits with Medicaid and other federal and state healthcare agencies. Pivotal to your success is hands-on knowledge of Government Auditing Standards, Generally Accepted Accounting Principles and applicable regulations of CMS Offices, State OIG, and related legislative practices and procedures.

In addition to your government auditing expertise, you will also be able to hold your own ground with hospital CEOs and other high-level decision-makers, exuding a polished demeanor and compelling confidence as you strive to develop strong working relationships with a variety of providers.

What Else You'll Bring to the Table

• Bachelor's degree in Accounting/Finance or related discipline; CPA is a plus.
• Minimum 3+ years of healthcare medical record documentation auditing background.
• Knowledge of the Medicaid/Medicare claims and reimbursement requirements.
• Medical record coding experience with a RHIT, CCS or CPC certification.
• Familiarity with Health and Human Services (HHS) programs.
• Analytical ability & business acumen to collect multiple sources of data and draw logical conclusions.
• Impeccable communication skills, including active listening and in presenting findings and recommendations.
• Solid computer proficiency with Microsoft office suite, including Word & Excel, to prepare reports, memos, summaries and analyses; knowledge of ACL and Teammate Audit Software is a plus.
• Ability to travel (approximately 35%).

What's in It for You

• Right time, right place to make an impact -- with billions of dollars at stake, HMS is committed to ensuring that all our operations comply with both the spirit and the letter of government regulations; you'll play a key role in this initiative as you audit medical record coding documentation of assigned providers and contractors to ensure compliance with the Texas Administrative Code and other state and federal Medicaid/Medicare regulations and make your mark as you shape and grow this strategically important product line.
• Visibility -- you'll touch every piece of our global operations and will come into contact with all levels of our organization; your contributions will be keenly watched by our executive management team.
• Career advancement -- you will be well positioned to transition into Management, auditing in other areas of the business, or other opportunities based on your ambition and aptitude.
• Autonomy & empowerment -- we'll entrust you with the freedom and flexibility to achieve your objectives independently with significant latitude for initiative and independent judgment.
• A culture of growth and transition -- we are positioned for explosive growth-- both organically and via acquisition -- but are also proactive about maintaining a culture in which employee input is welcome, initiative is encouraged, and excellence and innovation are highly valued.
• Excellent benefits -- in addition to a competitive salary and bonus (we offer bonuses every year regardless of performance), we offer a comprehensive benefits package that includes a 401(k) plan with generous employer match, flexible spending plans, and much more.

More About Your Role

This is an individual contributor role and you'll report directly to the Senior Auditor. Generally our desk audits run anywhere from 1-3 days, while our field audits span 5-10 days and you'll juggle 5-10 audits concurrently in various stages of completion.

You may be actively working on two or more audits while you schedule and do advance planning for the upcoming audits and finalize others as you report your findings. As with any auditing position, you will aim to meet and exceed your targets as you drive to results and show off your multitasking prowess to effectively prioritize and complete work within stringent deadlines.

Keys to Success

To excel in this role you will bring a strong understanding of medical coding documentation audits and Medicaid/Medicare audits and take a proactive and innovative approach to building strong relationships and maintaining high levels of communication with all stakeholders. You will balance a consultative, problem-solving style with an aggressive, entrepreneurial drive.

For example, if a provider refuses to be audited, you will be able to make your case with great tact and diplomacy, and quickly develop operational knowledge. You'll independently drive your audits, maintaining a big-picture focus while keeping a razor-sharp handle on day-to-day details and employing sound judgment to develop accurate assessments and recommendations.

And finally, you'll continually evaluate the post-planning data to meet and exceed your targets and drive best practices to sustain our growth objectives.

If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!

Who We Are

Health Management Systems has always been focused exclusively on the healthcare industry. In 1985, we began providing third party liability identification and recovery services to our first Medicaid agency client. Since then, we've partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars and save billions more through cost avoidance.

We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.

We are an equal opportunity employer. EOE M/F/D/V

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