Reopening Specialist

Role Snapshot

The Cost Report Auditor II Reopening's team is responsible for evaluating reopening requests submitted by healthcare providers, other auditors, or the Appeals department. These requests represent extensions of the original final settlements completed by the core audit teams. This role involves conducting focused reviews on specific issues identified in the reopening requests, ensuring alignment with regulatory and procedural standards. The position is expected to consistently meet established timeliness and quality benchmarks to maintain compliance with both internal and external quality review requirements.

Salary Range

$55,000 - $60,000

The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Work Location

We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

How do I know this opportunity is right for me? In this role you will:

• Evaluate reopening requests from both internal and external parties to determine the validity and justification for each request.
• Review approved reopening requests and identify any additional documentation or information needed to proceed with the review process.
• Create and/or utilize detailed workpapers to document the review process, ensuring thorough analysis and proper settlement determination.
• Upon completion of the reviews, prepare and finalize the Revised Notice of Program Reimbursement package, ensuring all details are accurate and complete.
• Serve as a primary point of contact for communication with various stakeholders, including providers, through phone, email, and other correspondence to address questions and clarify information as needed.
• Participate in various special projects throughout the year, supporting the audit and reopening processes.
• Ensure all relevant logs, databases, and tracking systems are updated with the completion dates and results of the reopening reviews to maintain accurate and current records.

Minimum Qualifications

• Bachelor's degree in Accounting, Finance, Business Administration, or a related field, or equivalent post-high school education and/or work related experience.
• 2 or more years of Medicare cost report auditing or related experience.
• Strong analytical and problem-solving abilities, with the capacity to evaluate complex information and make decisions.
• Exceptional organizational skills and a high level of attention to detail to ensure accuracy and completeness in all aspects of the work.
• Strong verbal and written communication skills, with the ability to effectively interact with internal teams, external stakeholders, and providers.
• Solid knowledge of CMS Medicare Cost Reporting and Government Auditing Standards.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
• Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

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This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services