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Audit & Reimbursement II-Appeals

  • Job Family: Audit
  • Type: Full time
  • Date Posted:
  • Req #: PS71621

Location:

  • IN, Indianapolis

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Description

Audit & Reimbursement II
Location: Remote open nationwide 

The Audit & Reimbursement II is responsible for completing limited and full desk reviews on providers as assigned. 

This position is part of the Medicare Administrative Contract (MAC) with the Centers for Medicare and Medicaid Services (CMS). This position will support the Medicare part A Audit& Reimbursement department. This includes, but not limited to, processing provider submitted Medicare cost reports. The intent of this position is to support the Medicare cost report appeals workload, however it may include the need to support all functions within the Audit & Reimbursement department. These functions include but not limited to: Cost report acceptance, tentative settlements, rate reviews, desk reviews, audits, final settlements, reopening, appeals and other compliance/reimbursement review.

Primary Purpose: The Audit and Reimbursement Auditor II, under guided supervision, will support audit activities of healthcare providers’ financial and statistical records in accordance with Government Auditing Standards (GAS). The auditor will receive training, participate in audit related workload, and have opportunities to participate on special projects. This position provides a valuable opportunity to gain exposure in the healthcare reimbursement and financial industry.

Primary duties applicable to the Medicare cost report Appeals workload include, but are not limited to:

  • Under guided supervision, participate in completing 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.
  • Document findings, prepare detailed work papers and present audit adjustment reports in accordance with GAS and CMS requirements
  • Analyze and interpret data per a provider’s trial balance, financial statements, financial documents or other related healthcare records
  • 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

Minimum Qualifications:

  • Requires a BA/BS degree and a minimum of 2 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 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 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.

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.


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 careers.ElevanceHealthinc.com. 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 ability@icareerhelp.com for assistance.

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