Audits Manager I (Reimbursements Manager - RHC, Home Health, and Hospice) / 60016471

Audits Manager I (Reimbursements Manager - RHC, Home Health, and Hospice) / 60016471

Salary

$66,400.00 - $119,500.00 Annually

Location

Richland County, SC

Job Type

FTE - Full-Time

Job Number

190102

Agency

Department of Health and Human Services

Division

Reimbursements.

Opening Date

07/01/2026

Closing Date

7/8/2026 11:59 PM Eastern

Class Code:

AN23

Position Number:

60016471

Normal Work Schedule:

Monday - Friday (8:30 - 5:00)

Pay Grade

GEN11

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 Agencys 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.

This is an in-office role and not a telecommute or remote position.

Are you the One? We are looking for an Audits Manager I (Reimbursements Manager - RHC, Home Health, and Hospice), who will administer quarterly and annual WRAP payment processes for Rural Health Clinic (RHC) providers. Ensuring RHC rates are updated in accordance with Medicare rate determinations. Reviews and approves Home Health cost report analyses for regulatory and methodological accuracy and calculates annual hospice rate updates in line with federal and state requirements. Conducts desk reviews and performs rate setting activities for non institutional Medicaid providers to ensure alignment with Federal regulations and State Medicaid policy. Performs financial analyses of proposed reimbursement methodologies and rate structures for new and existing Medicaid services.

• Manage the development, calculation, and implementation of SC Medicaid Rural Health Clinic (RHC) wrap around payments and annual rate updates. Review cost reports, encounter data, and federal/state reimbursement guidance to ensure accurate payment reconciliation between Medicaid managed care payments and the federally required RHC encounter rate. Validate provider-submitted data, resolve discrepancies, and ensure compliance with allowable cost principles and state plan requirements. Calculate clinic-specific or methodology-based RHC rates and prepare payment schedules in accordance with regulatory requirements. Coordinate with finance, policy, and program teams to ensure timely issuance of wrap payments and accurate communication of rate changes. Maintain audit-ready documentation for all calculations, data sources, methodologies, and approvals.
• Review annual Medicaid Home Health provider cost reports for accuracy, completeness, and compliance with state and federal requirements. Validate reported costs, utilization, staffing, and financial data to ensure adherence to allowable cost principles and program guidelines. Identify errors, anomalies, or inconsistencies and coordinate with providers to resolve findings. Conduct analytical reviews to assess cost trends and evaluate fiscal impacts on the Medicaid program. Using validated cost report data and approved rate setting methodologies, calculate Home Health reimbursement rates, ensuring they reflect accurate cost structures, policy requirements, and budget constraints. Prepare all rate documentation, supporting schedules, and fiscal impact analyses for internal review and leadership approval. Coordinate with finance, budget, and policy teams to ensure consistent methodology and timely implementation. Maintain audit ready records of all calculations, assumptions, and rate setting decisions.
• Conduct the full annual update of Medicaid hospice reimbursement rates in accordance with federal and state requirements. Review CMS issued rate components, wage indices, and statutory adjustments to ensure accurate application within the state's Medicaid program. Analyze historical expenditures, utilization trends, and budgetary constraints to determine the fiscal impact of updated rates. Coordinate with finance, budget, and policy units to validate data inputs and ensure consistency with federal guidance. Prepare updated rate files, documentation, and implementation materials for approval and dissemination. Communicate changes to internal stakeholders and providers, ensuring clarity in methodologies, effective dates, and billing expectations. Maintain audit-ready records of calculations, data sources, methodology decisions, and approvals.
• Performs fundamental supervisory and leadership functions in accordance with Department policies and procedures, best practices and Federal and State rules and regulations, especially with regard to Equal Employment Opportunity Commission (EEOC) standards. Maintains an effective organizational team and motivates diverse staff to accomplish mission critical operations and objectives. Promotes workforce engagement and a safe, professional, and productive work environment for all employees.
• Review provider contracts, amendments, and financial schedules for accuracy, completeness, and compliance with state and federal regulations. Verify contract language aligns with agency policies, reimbursement methodologies, and funding requirements. Identify discrepancies, risks, or fiscal impacts and recommend corrective actions.
• Analyze cost reports, utilization data, and budget benchmarks to support the development and adjustment of provider reimbursement rates.
• Perform additional duties as assigned within the specified timeframe and according to the directions made available at the time of the assignment.

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

A bachelors degree in accounting, business administration, finance, insurance, or a related field and experience in professional level accounting, auditing, or financial management.

An equivalent combination of education and experience may be accepted with prior State Human Resources approval.

Preferred: At least two (2) years managing accountants and/or auditors. Experience with Medicare or Medicaid reimbursement principles and cost report preparation. Knowledge of Medicaid and Federal/State regulations, rate setting methodologies, and accounting and financial management practices.

Additional Requirements:

• Sitting or standing for long periods of time.
• Lifting requirements: 25 lbs.
• In-office role.

Preferred Qualifications

• Knowledge of standard software applications (spreadsheets, macros, databases, reporting systems, etc.).
• Knowledge of data collection, reporting standards, and documentation requirements.
• Ability to exercise sound judgment and make data-based decisions in addition to working effectively with provider organizations and partner agencies.

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.

Benefits for State Employees

The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.

Insurance Benefits

Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.

Retirement Benefits

State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.

Workplace Benefits

State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.

Note: The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.

01

The responses you provide to these Supplemental Questions will be used in combination with your application to determine whether you meet the minimum qualification requirements. Please, thoroughly complete the Education and Work Experience sections of your application and the Supplemental Questions. Failure to provide detailed and complete information will result in your application being rejected. Any misrepresentation or omissions will result in your disqualification from employment and/or termination. You may not submit resumes in lieu of filling out the application or answering the Supplemental Questions. I acknowledge that I have read, understand, and agree with the above.

• Yes
• No

02

Please indicate your expected salary, if offered this position.

03

Do you have a bachelors degree or above in accounting, business administration, finance, insurance or a related field?

• Yes
• No

04

Do you have experience in professional-level accounting, auditing or financial management?

• Yes
• No

05

Do you wish to claim Veteran Preference? If yes, you must submit a copy of your DD214 Form with your job application in order to qualify and claim this preference.

• Yes
• No

06

How did you hear about this career opportunity?

Required Question

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 language used in this document does not create an employment contract between the employee and the agency. This document does not create any contractual rights or entitlements. The agency reserves the right to revise the content of this document, in whole or in part. No promises or assurances, whether written or oral, which are contrary to or inconsistent with the terms of this paragraph create any contract of employment.