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Elevance Health · 21 hours ago

Audit & Reimbursement III and Senior

Atlanta, GA

Full-time

Hybrid

Mid, Senior Level

3+ years exp

Elevance Health is a health company dedicated to improving lives and communities. They are seeking an Audit and Reimbursement III and Senior to support their Medicare Administrative Contract, focusing on auditing and financial analysis related to Medicare cost reports and reimbursement.

Health CareHealth InsurancePersonal HealthWellness

No H1B

U.S. Citizen Only

Responsibilities

Analyzes and interprets data and makes recommendations for change based on judgment and experience

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

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

Must be able to perform all duties of lower-level positions as directed by management

Participates in special projects and review of work done by auditors as assigned

Assist in mentoring less experienced associates as assigned

Perform complex cost report desk reviews

Perform complex cost report audits, serving as an in-charge auditor assisting other auditors assigned to the audit

Dependent upon experience, may perform supervisory review of work completed by other associates

Analyze and interpret data per a provider's trial balance, financial statements, financial documents or other related healthcare records

Perform cost report acceptance, interim rate reviews, final settlements and tentative settlements as assigned

Performs complex calculations related to payment exception requests and reviews exception request work papers prepared by others

Perform cost report reopenings

Under guided supervision, participate in completing more complex 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

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

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

Prepare and perform supervisory review of cost report acceptance, interim rate reviews, tentative settlements and final settlements as assigned

Prepare and perform supervisory review of cost report reopenings

Manage caseload of Medicare cost report Appeals, Position papers, Jurisdictional Reviews, PRRB Hearings, Administrative Resolutions, PRRB or CMS requests

Monitor all communications related to caseload

Maintaining accurate records by updating all logs, case files, tracking systems

Qualification

Audit experienceMedicare knowledgeFinancial analysisGovernment Auditing StandardsCMS regulationsAccounting degreeMicrosoft OfficeLeadership experienceProject managementProblem-solving skillsTime management

Required

Requires a BA/BS degree and a minimum of 3 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

Requires a BA/BS 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