Occ. Code 0442400
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ASSOCIATE MEDICAL FACILITIES AUDITOR, GRADE 23 |
0442400 |
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PRINCIPAL MEDICAL FACILITIES AUDITOR, GRADE 27 |
0442500 |
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CHIEF MEDICAL FACILITIES AUDITOR, M-3 |
0442700 |
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COORDINATOR OF MEDICAL FACILITIES AUDIT, M-4 |
0442800 |
New York State Department of Civil Service
Classification Standard
BRIEF DESCRIPTION OF CLASS SERIES
Positions in this series complete reimbursement audits of hospitals, nursing homes, managed care organizations and related medical facilities receiving Medicaid rates and services that are cost based or subject to audit for another reason. Additional audit responsibilities can include internal compliance, or operational audits, and reviews of fraud, waste and abuse activity of fee for service providers. Auditors analyze facility reported costs, data, and statistics that are used in the development of facility specific Medicaid rates, and may recommend and develop department policy and develop standards and procedures for the maintenance, review, and supervision of facility financial records. In addition, auditors identify, target, and conduct reviews of fee for service providers to ensure their compliance with governing statutes and regulations. These positions are found in the Department of Health and the Office of the Medicaid Inspector General.
DISTINGUISHING CHARACTERISTICS
ASSOCIATE MEDICAL FACILITIES AUDITOR: first supervisory level; incumbents have full responsibility for monitoring and controlling audits and/or assignments from beginning through the litigation process and are responsible for the supervision of subordinate auditors.
PRINCIPAL MEDICAL FACILITIES AUDITOR: second supervisory level; incumbents have full responsibility for monitoring and controlling audits and/or assignments from beginning through the litigation process and for the supervision of subordinate auditors/supervisors. Incumbents are also responsible for planning, coordinating, directing, and supervising the audit activities of a region or office.
CHIEF MEDICAL FACILITIES AUDITOR: first management level; incumbents participate in and/or are responsible for overseeing the planning, development, implementation and follow-up of medical facilities audits and/or reviews; establishing priorities among pending cases and evaluation of manpower requirements; providing administrative supervision to assigned audit staff; resolving technical conflicts that may arise; reporting audit statuses to the Audit Director; and handling and resolving audits through the litigation process. Incumbents generally have responsibility over a region or regions, and/or serve as an Assistant Director to a larger bureau.
COORDINATOR OF MEDICAL FACILITIES AUDIT: director level; incumbents generally have supervision over a bureau or a regional office and are involved in proper application of governing regulations and the establishment of Department/Office policy regarding any governing regulations.
RELATED CLASSES
Management Specialists conduct or supervise comprehensive audits of the management, program, and fiscal affairs of local social services districts and of providers of health care or other services. Incumbents perform eligibility reviews of applicants for and recipients of public assistance for the purpose of determining compliance with State and federal statutes, regulations, and billing protocols. They may also be assigned to Central Offices to support field staff or work on projects that encompass programmatic reviews or special tasks as assigned.
Senior Auditors function as journey level auditors performing the full range of activities associated with the conduct of financial and performance audits. Incumbents may work independently or may be assigned to an audit team. The work consists of in-depth analysis of fiscal affairs and operational practices of a variety of organizations that do business with New York State agencies.
Associate Auditors supervise and train a staff of three or more Senior Auditors and trainees, and may be in charge of a particular organization. On a large or complex audit, they may be responsible for a particular section or functional area of the organization being audited. The work consists of supervising the conduct of in-depth analyses of the fiscal affairs and operational practices of a variety of organizations that do business with New York State agencies. For both positions, the nature of work often involves confidential and sensitive matters.
ILLUSTRATIVE DUTIES
ASSOCIATE MEDICAL FACILITIES AUDITOR
Complete preliminary review of audit packages and target or assist in targeting of audit areas.
· Review prior audit reports, correspondence, and State and federal regulations related to audits.
· Review audit plans with assigned staff.
· Meet with health care provider representatives (administrators, directors of finance, accountants, and attorneys) to explain the audit process and procedures.
· Make arrangements for and conduct and/or supervise multiple field audits at multiple locations.
Supervise subordinate staff.
· Provide supervision, guidance, and oversight to subordinate staff, and intervene and resolve problems as necessary.
· Determine and oversee staff assignments.
· Review, monitor, and evaluate staff performance.
· Complete performance evaluations.
· Identify training needs and arrange for provision of training.
· Manage and direct program activities by setting priorities and deadlines.
· Train staff as necessary in audit steps and protocols.
· Review subordinates work papers for regulation and policy compliance as well as accuracy.
· Confer with audit manager to resolve audit issues and report audit progress.
Assist and/or prepare written material including memos, letters, and various reports as required by the Department/Office.
· Assist Department/Office legal staff as needed and, if necessary, testify on behalf of the Department/Office at any legal hearings and/or proceedings.
PRINCIPAL MEDICAL FACILITIES AUDITOR
May perform all of the same duties and functions as an Associate Medical Facilities Auditor.
Provide direction to audit teams in carrying out necessary audit functions.
· Prepare staff assignments based on Department/Office priority.
· Direct and approve the preparation and implementation of audit plans for specific audits.
· Inform staff of audit guidelines, regulations, and policy where necessary.
· Approve audit hours and level of staff for individual audits.
Monitor audit progress and prepare necessary administrative reports.
· Review completed audit work paper file to determine clarity, content and compliance with audit guidelines, and support of audit findings.
· Review, edit, and approve the various audit reports prepared by audit staff.
· Oversee audits through final resolution and completion.
· Inform staff of changes in procedures, rules, and regulations by preparing and issuing audit directives, plans, and protocols.
· Monitor and control audit activities related to one or more projects.
CHIEF MEDICAL FACILITIES AUDITOR
May perform all of the same duties and functions as lower-level Medical Facilities Auditors.
Oversee the planning, development, implementation and follow-up of audits and/or reviews.
· Establish priorities among pending cases and evaluate personnel resource requirements.
· Provide functional and administrative supervision and direction to audit staff and ensure adherence to policies and procedures.
· Disseminate and assure uniform application of policies and provide expertise and direction to audits.
· Review audit reports and work papers for adherence to Department/Office standards, completeness, consistency, and accuracy.
In conjunction with the Principal MFA, resolve outstanding audit issues through the litigation process.
· Provide technical assistance and advice to legal staff in preparation of cases and provide testimony at hearings.
· Manage, train, and supervise multiple staff in multiple locations.
· Manage audit, program, and systems activities.
COORDINATOR OF MEDICAL FACILITIES AUDIT
May perform all of the same duties and functions as lower-level Medical Facilities Auditors.
Serve as a Bureau Director within the Department of Health and the Office of the Medicaid Inspector General, or sometimes as a director of a regional office.
· Prepare staff assignments based on competing priorities in respective areas/regions.
· Inform staff of changes in procedures, rules, and regulations by preparing and issuing audit directives, plans, and protocols.
· Analyze proposed and promulgated regulations and directives as to their effectiveness and impact on the Medicaid Program and providers.
· Administer and direct the management, program, and fiscal audit, and eligibility review activities.
· Direct the preparation of work plans and budget proposals.
Full responsibility for monitoring and controlling audits through the litigation process and for the supervision of staff.
· Review audit reports and work papers for completeness, consistency of findings, and accuracy.
· Prepare for administrative hearings and/or court proceedings by preparing witnesses, training staff on testifying techniques, and developing strategies for presenting audit findings and purposes.
· Respond to complaints or appeals from providers.
· Testify in administrative hearings and appropriate courts regarding audit findings and matters involving violations of regulations.
Formulate policy.
· Develop and modify operational procedures and instruments relating to auditing of health care providers.
· Direct the development of audit guidelines, manuals, and other training materials.
· Function as the focal point for policy questions arising in the bureau/office.
· Serve as a policy expert and provide policy recommendations to executive staff.
MINIMUM QUALIFICATIONS
ASSOCIATE MEDICAL FACILITIES AUDITOR
Promotion: one year of permanent competitive service as a Senior Auditor; or as a Management Specialist 1, Management Specialist 1 (Children and Family Services), or Management Specialist 1 (Spanish Language); and 24 college credits in accounting.
PRINCIPAL MEDICAL FACILITIES AUDITOR
Promotion: one year of permanent competitive service as an Associate Medical Facilities Auditor; OR as a Management Specialist 2, Management Specialist 2 (Children and Family Services), or Management Specialist 2 (Spanish Language); and 24 college credits in accounting.
CHIEF MEDICAL FACILITIES AUDITOR
Promotion: one year of permanent competitive service as a Principal Medical Facilities Auditor; OR as a Management Specialist 3 or Management Specialist 3 (Children and Family Services); and 24 college credits in accounting.
COORDINATOR OF MEDICAL FACILITIES AUDIT
Promotion: one year of permanent competitive service as a Chief Medical Facilities Auditor or Principal Medical Facilities Auditor; OR as a Management Specialist 3 or Management Specialist 3 (Children and Family Services); and 24 college credits in accounting.
Date: 11/09
NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe. Standards cannot and do not include all of the work that might be appropriately performed by a class. The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written. Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.