Audit & Reimbursement III and Senior

About the role

This role enables associates to work virtually full-time, except for 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

• Analyzes and interprets data and makes recommendations for change based on judgment and experience.
• Able to work independently on assignments and under minimal guidance from the manager.
• Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements.
• Gain experience with applicable Federal Laws, regulations, policies and audit procedures.
• Respond timely and accurately to customer inquiries.
• Ability to multi-task while independently and effectively prioritizing work using time management, initiative, project management and problem-solving skills.
• Must be able to perform all duties of lower-level positions as directed by management.
• Participates in special projects and review of work done by auditors as assigned.
• Assist in mentoring less experienced associates as assigned.
• Perform complex cost report desk reviews.
• Perform complex cost report audits, serving as an in-charge auditor assisting other auditors assigned to the audit.
• Dependent upon experience, may perform supervisory review of work completed by other associates.
• Analyze and interpret data per a provider's trial balance, financial statements, financial documents or other related healthcare records.
• Perform cost report acceptance, interim rate reviews, final settlements and tentative settlements as assigned.
• Perform complex calculations related to payment exception requests and reviews exception request work papers prepared by others.
• Perform cost report reopenings.
• Under guided supervision, participate in completing more complex appeals related work: Position papers, Jurisdictional Reviews, PRRB Hearings, Administrative Resolutions, PRRB or CMS requests.
• Maintain accurate records by updating all logs, case files, tracking systems.

Requirements

• Requires a BA/BS degree and a minimum of 3 years of audit/reimbursement or related Medicare experience; or any combination of education and 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 meet the residency requirement of living in the United States at least three of the past five years.

Qualifications

• 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. Must obtain Continuing Education Training requirements (where required).

Skills

• 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, CIA or CFE preferred.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.

Pay

• Audit & Reimbursement Sr: $75,696 to $125,496
• Audit & Reimbursement III: $63,156 to $104,706

Schedule

• Virtually full-time, except for required in-person training sessions.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.