Audit & Reimbursement III
Anthem Blue Cross & Blue Shield
Position Title:Audit & Reimbursement III
Audit & Reimbursement III
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)
This position reports to the National Government Services, Inc. subsidiary. The Audit and Reimbursement III 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). Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement. They will participate in contractual Audit and Reimbursement workload, and have opportunities to participate on special projects. This position provides a valuable opportunity to gain further 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 completing more complex Audit & Reimbursement functions
How you will make an impact:
- 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.
- 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.
- Performs 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
- Maintaining accurate records by updating all logs, case files, tracking systems
- Participate in all team meetings, staff meetings, and training sessions
- Requires a BA/BS degree and a minimum of 5 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.
- 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).
- 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.