Financial Reviewer

UMR Field Office Financial Representative

Job Duties and Responsibilities: This position will be responsible for conducting financial reviews of NF MA billing practices with follow-up reporting, analysis, processing claim adjustments and attending hearings to defend findings.

Provide Technical Assistance and act as a resource for exchange of information through verbal and/or written communication with NF to enhance awareness of applicable financial state and federal regulations.
Act as a resource for dissemination of information, research and updates for UMR team members.
Perform review of resident personal care funds/trust accounts to assess appropriateness of expenditures and presence of NF fiduciary control.
Analyze NF accounts receivable to identify MA overpayments and when appropriate, take action to recover these overpayments.
Be knowledgeable of all applicable Department, State and Federal regulations as they pertain to financial reviews.
Perform financial review and follow-up reviews according to established guidelines.
Conduct specialized financial reviews as assigned.
Prepare and coordinate all necessary work to organize and carry out a financial review.
When conducting specialized reviews, notify NF of review date(s) and records required. Follow up to confirm receipt of information.
Analyze previous review documentation for recurring trends and to project utilization of resources (pre-review and on-site).
Compare MA Status Change Report with NF records for correct payor source and accuracy of census data.
Identify financial non-compliance issues and refer to the appropriate Area Supervisor.
Process claim adjustments according to established procedures for all inappropriate billing.
Monitor the status of all submitted claim adjustments until the process is completed.
Perform entrance and exit conferences for financial reviews with facility representatives to explain financial review process and to present the results of the review.
Compile and analyze information following a financial review and prepare/present a Financial Review Summary.
Perform all post-review functions, prepare and submit necessary information for NFs, field office and headquarters (including Monthly Recovery Report, etc.) and others as required.
Process Facility Alert/Act 28 forms to notify appropriate agencies of issues identified during a review. (see attachment B)
Attend formal hearings to present and defend financial recommendations made as a result of reviews.
Attend meetings, seminars and educational conferences pertaining to financial issues to keep informed of current trends and changes.
Be knowledgeable and proficient in the use and maintenance of office equipment utilized by the Department.
Demonstrate a working knowledge of various computer software applications used by the Department to perform job functions, including Excel, Word, Access, Outlook, MAMIS, Promise, Internet Explorer and such other specialized software as necessary to perform research tasks.
Travel to NFs and other locations in the state to perform job functions.
Prepare a monthly report of financial recoveries, pending recoveries to be submitted to the LTC Audit Specialist.
Work Schedule: 37.5 hours per week Monday through Friday


REQUIREMENTS
Required: Must have accounting and analytical skills. Bachelor Degree in Accounting with 12-24 Post Secondary Accounting credits desired. Experience in health care accounts receivable and cost reporting beneficial. A working knowledge of various computer database and spreadsheet applications also needed.