Audit & Reimbursement II

About the role

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Responsibilities

• Completes limited and full desk reviews on providers as assigned.
• Assists higher level auditor on field work and appeals as assigned.
• Completes interim rate reviews, tentative settlements, and final settlements of providers as assigned.
• Performs special audits of End Stage Renal Disease (ESRD) providers and provider exception requests as assigned.
• Updates STAR, FISS, and PSF as assigned.
• Participates as a team member on audits of provider's records and other projects.
• Analyzes and interprets data and makes recommendations for change based on their judgment and experience.
• May perform Part A provider enrollment responsibilities as needed.

Requirements

• Requires a BA/BS degree in Finance/Accounting/Business or any combination of education and related experience, which would provide an equivalent background.
• This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years.

Preferred Skills, Capabilities, And Experiences

• Degree in Accounting preferred.
• Knowledge of CMS program regulations and cost report format preferred.
• Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
• MBA, CPA or CIA preferred.

Benefits

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $56,960-$89,712. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Schedule

No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Equal Opportunity Employer

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.