Audit & Reimbursement Senior
Elevance Health

Job Info

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Audit & Reimbursement Senior - Medicare Cost Report Audit

Locations: This is a United States based, virtual position.

National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

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). This individual 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.

How you will make an impact:

• Prepare and perform supervisory review of cost report desk reviews and audits.
• Review of complex exception requests and CMS change requests.
• 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.
• 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.

Minimum Requirements:

• 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 Skills, Capabilities and Experiences:

• Knowledge of CMS program regulations and cost report format, and CMS computer systems.
• Degree in Accounting or other Business related degree.
• Demonstrated leadership experience preferred.
• Knowledge of Microsoft Word and Excel.
• A valid driver's license and the ability to travel may be required.

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.

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