Audit & Reimbursement Lead - Wellpoint Federal

About the role

The Audit & Reimbursement Lead role is responsible for providing technical direction, workload planning, associate mentoring, and operational support. This role is part of Wellpoint Federal, a subsidiary of Elevance Health, which delivers solutions across claims administration, data, and care delivery to support federal programs.

Responsibilities

• Reviews work of associates to ensure they follow appropriate guidelines
• Provides training/mentoring both in a formal and informal setting
• Maintains workload inventory to ensure timely completion
• Handles complex case research and resolutions
• Affords assistance to management with workload and financial budget responsibilities
• Works with management on interactions with internal and external audits and performance measures
• Assists management on monitoring and training lower-level staff
• Analyzes and interprets data with recommendations based on judgment and experience
• Performs all duties of lower-level positions as directed by management
• Participates in development and maintenance of Audit & Reimbursement standard operating procedures
• Participates in workgroup initiatives to enhance quality, efficiency, and training
• Participates in special projects as needed
• Performs supervisory review of cost report desk reviews and audits
• Performs supervisory review on complex areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition, Wage Index, and all cost-based principles

Requirements

• BA/BS degree and minimum of 8 years audit/reimbursement or related Medicare experience, including previous experience at a Senior Auditor level in health care, public accounting, or a government agency
• Knowledge of CMS program regulations and cost report format, and CMS computer systems
• Knowledge of Microsoft Word and Excel
• Effective verbal and written communication skills
• Effective organization and time management skills
• Effective problem-solving skills
• Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization
• Experience in software used to file and finalize cost reports and experience with paperless audit software applications
• Demonstrated leadership experience; thorough knowledge of CMS program regulations and cost report format
• A valid driver's license and the ability to travel may be required

Preferred Skills, Capabilities And Experiences

• Preferred degree in Accounting or other Business Related degree
• Preferred knowledge of CMS program regulations and cost report format, and CMS computer systems
• Preferred knowledge of Microsoft Word and Excel
• Preferred effective verbal and written communication skills
• Preferred effective organization and time management skills
• Preferred effective problem-solving skills
• Preferred excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization
• Preferred experience in software used to file and finalize cost reports and experience with paperless audit software applications
• Preferred demonstrated leadership experience; thorough knowledge of CMS program regulations and cost report format

Benefits

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and a 401(k) match. Additional benefits include medical, dental, vision, short and long term disability benefits, life insurance, wellness programs, and financial education resources.