Audit & Reimbursement III
Audit & Reimbursement III
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Job Description
Anticipated End Date:
Position Title:
Audit & Reimbursement IIIJob Description:
National Government Services is a proud member of Elevance Healths family of brands. Weadminister government contracts for Medicare and partner with the Centers forMedicare and Medicaid Services to transform federal health programs.
Audit & Reimbursement III
Location: This role enables associates to work virtually fulltime with the exception of required inperson training sessions providing maximum flexibility and autonomy. This approach promotes productivity supports worklife integration and ensures essential facetoface onboarding and skill development.
The Audit & Reimbursement III will be responsible for completing limited and full desk reviews on teaching organ acquisition hospitals and other complex provider cost reports.
How you will make an impact:
Plans directs and controls specific provider audits.
In charge auditor on large and/or complex field audits.
Responsible for assigning reviewing and approving the work performed by auditors on team audits.
Responsible for completing interim rate reviews final settlements and tentative settlements as assigned.
Will support the Appeal Unit with appeal issues as assigned.
Participates in special projects and review of work done by lower level auditors as assigned.
Performs complex calculations related to payment exception requests and reviews exception request workpapers prepared by others.
Analyzes and interprets data and makes recommendations for change based on judgment and experience.
May perform Part A provider enrollment responsibilities as needed.
Minimum Requirements:
Associates in this role are expected to maintain continuing education requirements.
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 ispart 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 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.
A valid drivers license and the ability to travel to worksite and other locations as necessary.
If this job is assigned to any Government Business Division entity the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances segregation of duties principles role specific training monitoring of daily job functions and sensitive data handling instructions. Associates in these jobs must follow the specific policies procedures guidelines etc. as stated by the Government Business Division in which they are employed.
Job Level:
NonManagement ExemptWorkshift:
Job Family:
AFA > Audit Comp & RiskPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.
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.
How We Work
At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success for our consumers our associates our communities and our business.
We offer a range of marketcompetitive 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. Unless 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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Employment Type
Full Time
