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Audit & Reimbursement Lead

  • Job Family: Audit
  • Type: Full time
  • Date Posted:
  • Req #: JR23642


  • VA, Richmond
  • NY, East Syracuse
  • IN, Indianapolis
  • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
  • ME, South Portland



Audit & Reimbursement Lead

Location: Remote open nationwide

Responsible for providing technical direction, workload planning, associate mentoring and operational support on a day-to-day basis.

Primary duties may include, but are not limited to:

  • Reviews work of the associates to ensure they are following the appropriate guidelines
  • Provides training/mentoring both in a formal and informal setting
  • Reviews the policies and procedures to make sure they are appropriate
  • Monitors workload inventory to ensure timely completion
  • Handles complex case research and resolutions
  • Participates in special projects and review of work done by auditor
  • Analyzes and interprets data and makes recommendations for change based on their judgment and experience
  • 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
  • Actively participate in development of Audit & Reimbursement standard operating procedures
  • Actively participate in workgroup initiatives to enhance quality, efficiency and training
  • Participate on special projects as needed
  • Mentor staff as assigned

Choose from below based on specific job function hiring for:

  • Perform supervisory audit review on all areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition and all cost based principles
  • Coordinate crossover work with the Reopening team

Minimum Qualifications:

  • 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 FGS (Federal 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:

  • Degree in Accounting or other Business related degree
  • Experience in software used to file and finalize cost reports and experience with paperless audit software applications
  • Demonstrated leadership experience; thorough knowledge of CMS program regulations and cost report format
  • A valid driver's license and the ability to travel may be required

Colorado Compensation Mandate:  

Applicable to Colorado Applicants Only 

Annual Salary Range*: $85,428 - $106,785

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.  

* The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. 

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates 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.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at 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.

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