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Audit & Reimbursement II-S10 (US)

Anthem Blue Cross & Blue Shield

Anthem Blue Cross & Blue Shield

Virginia, USA · Atlanta, GA, USA · Atlanta, GA, USA · Peachtree City, GA, USA · Baltimore, MD, USA · Baltimore, MD, USA · Denison, TX, USA · Denison, TX, USA · Richmond, VA, USA · Framingham, MA, USA · Cincinnati, OH, USA · Harrisburg, PA, USA · Harrisburg, PA, USA · South Portland, ME, USA · Portland, OR, USA
Posted on Saturday, August 5, 2023

Position Title:

Audit & Reimbursement II-S10 (US)

Job Description:

Audit & Reimbursement II- S10

This is a hybrid position. The ideal candidate will live within 50 miles of one of our NGS Elevance Health offices (Office locations: Indianapolis, IN, Denison, TX, Harrisburg, PA, Hingham, MA, Baltimore, MD, South Portland, ME, Cincinnati, OH, Richmond, VA, and Atlanta, GA)

The Audit and Reimbursement S-10 Auditor II, under guided supervision, will support audit activities of healthcare providers’ financial and statistical records in accordance with Government Auditing Standards (GAS). The Auditor II will gain experience on Medicare Part A Audit and Reimbursement as part of our Medicare Administrative Contract (MAC) with the Federal Government (The Centers for Medicare and Medicaid Services (CMS) branch of the Department of Health and Human Services) specifically in the area of Worksheet S-10 audits. The auditor will receive training, participate in our Audit and Reimbursement workload, and have opportunities to participate on special projects. This position provides a valuable opportunity to gain exposure in the healthcare reimbursement and financial industry.

Entry level position responsible for basic Audit & Reimbursement functions

How will you make an impact:

  • Analyzes and interprets data and makes recommendations for change based on their judgment and experience.
  • Interacts with the provider community and provider consultants regarding payments to providers, etc.
  • Document findings, prepare detailed work papers and present audit adjustment reports in accordance with 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.
  • Responsible for completing limited and full desk reviews on providers as assigned.
  • Performs audit work scoped by the S-10 desk reviews and will be the in-charge auditor on S-10 audits. Assists higher level auditor on audit work and appeals as assigned.
  • Perform supervisory review on less complex Medicare cost reports.
  • Analyze and interpret data per a provider’s trial balance, financial statements, financial documents or other related healthcare records.

Minimum Qualifications:

  • Requires a BA/BS degree or a minimum of 2 years of Medicare 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 NGS (National Government Services) 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.

Preferred Qualifications:

  • Knowledge of Microsoft Word and Excel.
  • Degree in Accounting or other Business related degree.
  • A valid driver's license and the ability to travel may be required.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

AFA > Audit, Comp & Risk

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.