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Audit & Reimbursement Lead- Medicare Cost Report Appeals

  • Job Family: Audit
  • Type: Full time
  • Date Posted:
  • Anticipated End Date:
  • Reference: JR104922





Audit & Reimbursement Lead- Medicare Cost Report Appeals

This is a virtual position, the ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

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 Lead will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division within the Department of Health and Human Services).  Under direction of management, the Audit and Reimbursement Lead will provide technical leadership, supervision and coordination on contractual workload involving the Medicare cost report and Medicare Part A reimbursement.  This position provides a valuable opportunity to lead team members performing 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 :

  • Reviews work of the associates to ensure they are following the appropriate guidelines.
  • Provides training/mentoring both in a formal and informal setting.
  • Monitors workload inventory to ensure timely completion.
  • Handles complex case research and resolutions.
  • Assists management with workload and financial budget responsibilities.
  • Must have extensive knowledge of CMS principles, law, and regulations.
  • Works with management on interaction with internal and external audits and performance measures
  • Assist management on monitoring and training lower-level staff.
  • 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 on special projects as needed.
  • Perform supervisory review of cost report desk reviews and audits.
  • Perform supervisory review of cost report acceptance, interim rate reviews, tentative settlements, and final settlements as assigned.

Minimum Requirements :

  • Requires a BA/BS degree and a minimum of 8 years audit/reimbursement or related Medicare experience which includes previous experience at a Senior Auditor level in health care, public accounting, or a government agency; 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: 

  • Accounting degree preferred.
  • Experience in software used to file and finalize cost reports and experience with paperless audit software applications preferred. 
  • Demonstrated leadership experience; through 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, CIA or CFE preferred. 
  • Must obtain Continuing Education Training requirements (where required).
  • A valid driver's license and the ability to travel may be required.


Please 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 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. 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. 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 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 elevancehealthjobssupport@elevancehealth.comfor assistance.

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