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Audit & Reimbursement Sr

Anthem Blue Cross & Blue Shield

Anthem Blue Cross & Blue Shield

Virginia, USA · Baltimore, MD, USA · Baltimore, MD, USA · Denison, TX, USA · Denison, TX, USA · Richmond, VA, USA · Framingham, MA, USA · Cincinnati, OH, USA · Hingham, MA, USA · Hingham, MA, USA · Harrisburg, PA, USA · Harrisburg, PA, USA · South Portland, ME, USA · Portland, OR, USA
Posted on Monday, September 11, 2023

Position Title:

Audit & Reimbursement Sr

Job Description:

Audit & Reimbursement Senior

This is a hybrid position, with preference for the candidate to be located within 50 miles of a NGS Elevance Health office (Office locations: Indianapolis, IN, Denison, TX, Harrisburg, PA, Hingham, MA, Baltimore, MD, South Portland, ME, Cincinnati, OH, Richmond, VA, and Atlanta, GA)

Primary Purpose: This position reports to the National Government Services, Inc. subsidiary. The Audit and Reimbursement Senior will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A reimbursement. This position provides a valuable opportunity to gain advanced experience in auditing and financial analysis within a growing healthcare industry. This position allows for educational opportunities leading to certifications and promotes a well-balanced lifestyle that includes professional networking opportunities.

Responsible for all activities of an audit or reimbursement team

How you will make an impact:

  • Evaluate the work performed by other associates to ensure accurate reimbursement to providers.
  • Assist Audit and Reimbursement Leads and Managers in training, and development of other associates.
  • Participates in special projects as assigned.
  • 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.
  • Analyze and interpret data with recommendations based on judgment and experience.
  • Must be able to perform all duties of lower-level positions as directed by management.
  • Participate in development and maintenance of Audit & Reimbursement standard operating procedures.
  • Participate in workgroup initiatives to enhance quality, efficiency, and training.
  • Participate in all team meetings, staff meetings, and training sessions.
  • Assist in mentoring less experienced associates as assigned.
  • Prepare and perform supervisory review of cost report desk reviews and audits.
  • Perform supervisory review of workload involving complex areas of Medicare part A reimbursement such as Medicare DSH, Bad Debts, Medical Education, Nursing and Allied Health, Organ Acquisition, Wage Index and all cost based principles.
  • Prepare and perform supervisory review of cost report reopenings.
  • Manage caseload of Medicare cost report Appeals
    • Position papers
    • Jurisdictional Reviews
    • PRRB Hearings
    • Administrative Resolutions
    • PRRB or CMS requests
    • Monitor all communications related to caseload
    • Maintaining accurate records by updating all logs, case files, tracking systems

Minimum Qualifications:

  • Requires a BA/BS and a minimum of 8 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 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:

  • Accounting degree preferred.
  • Knowledge of CMS program regulations and cost report format preferred.
  • Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
  • Must obtain Continuing Education Training requirements.
  • MBA, CPA, CIA or CFE preferred.
  • Demonstrated leadership experience preferred.
  • A valid driver's license and the ability to travel may be required.

Job Level:

Non-Management Exempt


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.