Professional Auditor / 60020634 Position Available In Richland, South Carolina

Professional Auditor / 60020634

Salary
$52,100.00

• $88,600.00 Annually
  Location Richland County, SC
  Job Type
  FTE
• Full-Time
  Job Number
  177102
  Agency
  Department of Health and Human Services
  Division
  Reimbursements.

Opening Date
06/12/2025
Closing Date
6/19/2025 11:00 PM Eastern

Class Code:

AN19

Position Number:

60020634

Normal Work Schedule:

Monday

• Friday (8:30
• 5:00)
  Pay Band
  Band 5
  Hiring Range
• Min.
  $52,100.00
  Hiring Range
• Max.

$52,000.00
Opening Date
06/12/2025
EEO Statement
Equal Opportunity Employer

Agency Specific Application Procedures:

Failure to provide detailed and complete information may result in your application not being referred.
Veteran Preference Statement
South Carolina is making our Veterans a priority for employment in state agencies and institutions.

DESCRIPTION

BENEFITS
QUESTIONS
Job Responsibilities
The Agency’s mission is to be boldly innovative in improving the health and quality of life for South Carolinians.
This position is located in Reimbursements, Richland County.
Are you the One? We are looking for a Professional Auditor who will, under general supervision, serves as the point of contact for all FQHC provider change in scopes (CIS) and supports Audit team with duties related to Nursing Home and Hospice providers. Approves the mathematical and statistical reviews of all FQHC Change In-Scope rate requests. Maintains accurate FQHC contact information, records, cost reports, and serves as the point of contact for FQHC provider related inquiries. Performs the quarterly Nursing Home UPL calculations, completes the NH license bed utilization reports for the Department of Public Health, and cross trains on RHC Wrap Payment Methodology.
Responds to all FQHC provider inquiries and correspondence regarding change in scope rate reviews. Communicates process with provider, including but not limited to, sending CIS forms for completion, requesting cost reports or backup documentation. Audits and performs reviews of both Agency claim data and MCO data to determine settlement for provider, based on updated rate due to CIS. Completes rate change request forms as necessary and serves as point of contact throughout process for provider. Communicates and escalates issues during settlement calculation with Audit Manager and Director of Reimbursements, where necessary.
Facilitates the Nursing Home Upper Payment Limit (UPL) process each quarter. Communicates with providers regarding UPL submission timeline and sends them documentation to complete. Monitors receipt of documentation from providers to complete the UPL calculation. Complete calculations for all providers and notify the providers of the state match payment amount required. Submit the UPL calculations for review and payment and ensure all match payments are received and submitted to Accounts Receivable, where applicable. Responds to all inquiries with Nursing Homes regarding the UPL and maintains UPL workbook and email documentation.
Completes the Nursing Home License Bed Utilization report for the Department of Public Health. Pulls all Agency claim data from SAS and completes the Utilization workbook for review by the Audit Manager and Bureau leadership. Responds to all inquiries from the Department of Public Health (DPH) regarding utilization report and submits completed and reviewed/approved workbook to DPH.
Receives final audits from the Office of the State Auditor (OSA) of Nursing facilities and rates. Reviews facility claim data for the specified period and performs calculations with new rate(s) from the OSA. Initiates payment, or recoupment, dependent upon updated rate and notifies provider of action. Submits payment/recoupment information for review and completes all necessary internal Agency forms required (DHHS 1158, DHHS 115, etc.).
Performs other duties as assigned for the Wrap Payment, FQHC, Nursing Home, and Home Health audit team. May require travel to off-site meetings.
Cross trains on current RHC Wrap Payment Methodology and is able to conduct second reviews for Quarterly Interim Wrap settlements, as needed, as well as the Annual Final Wrap Settlements. Assists the team in maintaining the RHC Provider Email contact listing used for Wrap Payment settlement notification disbursement. Supports team in time of high volume, to ensure timely completion of quarterly and annual wrap payment settlements.
The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
13 paid holidays.
State Retirement Plan and Deferred Compensation Programs.
Minimum and Additional Requirements
An associate degree and experience in accounting, auditing, finance, insurance, or tax preparation and/or analysis. A bachelor’s degree with multiple accounting courses may be substituted for the work experience.

Additional Requirements:

Sitting or standing for long periods of time.
Liftin requirements: 20 lbs.
Valid driver’s license
Preferred Qualifications
Knowledge of the Department’s mission, programs and objectives; Ability to manage work; Ability to exercise judgment and discretion;
Ability to establish and maintain effective working relationships and communicate effectively; Ability to work independently; Ability to interpret and apply rules and regulations with the constraints presented; Ability to communicate complex information effectively in all formats including written and verbal. Must be able to meet deadlines with accuracy; Ability to conceptualize needed change and to initiate appropriate activities to move from concepts to implementation; knowledge of state government fiscal policies, procedures and processes. Employee in this position reports to the Audits Manager I. Employee must exercise good judgment and attention to detail. Ability to interpret SAS and MARS reports to complete job functions, as well as SCEIS data. Working knowledge of Microsoft Excel. Familiarity with Medicaid and Medical CPT codes.
Additional Comments
Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.
The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.
Employer
State of South Carolina
Agency
Department of Health and Human Services
Address
1801 Main Street, Suite 224
Columbia, South Carolina, 29201
Phone
803-898-2670
THE

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