Audit & Reimbursement III and Senior

Audit & Reimbursement III Location: This role enables associates to work virtually full-time, except for required in‑person training sessions, providing maximum flexibility and autonomy. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The Audit & Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government. Under guided supervision, the role will gain experience on complex issues involving the Medicare cost report and Medicare PartA reimbursement, participate in contractual audit and reimbursement workload, and work on special projects. Responsibilities Analyze and interpret data, making recommendations for change based on judgment and experience. Work independently on assignments with minimal guidance from management. Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements. Respond timely and accurately to customer inquiries. Perform complex cost report desk reviews, audits, acceptance, interim rate reviews, final settlements, tentative settlements, and reopenings. Conduct supervisory review of work completed by other associates (dependent on experience). Analyze financial documents and healthcare records, including provider trial balances and financial statements. Perform complex calculations related to payment exception requests and review exception request work papers. Participate in special projects, mentoring less experienced associates, and review work performed by auditors. Maintain accurate records by updating logs, case files, and tracking systems. Participate in all team meetings, staff meetings, and training sessions. Minimum Requirements BA/BS degree and a minimum of 3 years of audit/reimbursement or related Medicare experience (or an equivalent combination of education and experience). Foreign national applicants must meet the residency requirement of living in the United States for at least three of the past five years (CMS TDL190275). Preferred Skills, Capabilities, and Experiences Accounting degree preferred. Knowledge of CMS program regulations and cost report format preferred. Strong knowledge of CMS computer systems and Microsoft Office Word and Excel preferred. MBA, CPA, or CIA preferred. Must obtain Continuing Education Training requirements where required. Valid driver’s license and ability to travel may be required. Salary and Benefits Salary: Audit & Reimbursement III$63,156 to $104,706. Locations: Maine; Maryland; Massachusetts; New York; Virginia. Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, 401(k) contribution, medical, dental, vision, short- and long‑term disability benefits, and other benefits (subject to eligibility). The salary is based on legitimate, non‑discriminatory factors set by the company. Equal Employment Opportunity Statement Elevance Health is an Equal Employment Opportunity employer. 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 accommodations for accessibility should submit the Accessibility Accommodation Request Form; a team member will be in contact. Qualified applicants with arrest or conviction records will be considered in accordance with all federal, state, and local laws. Audit & Reimbursement Senior Location: This role enables associates to work virtually full‑time, except for required in‑person training sessions, providing maximum flexibility and autonomy. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services. The Audit & Reimbursement Senior will support our Medicare Administrative Contract (MAC), focusing on complex Medicare cost reports and Medicare PartA reimbursement. The position offers advanced experience in auditing, financial analysis, and supervisory responsibilities. Responsibilities 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. Participate in special projects as assigned. Work independently on assignments with minimal guidance from management. Prepare detailed work papers and present findings in accordance with GAS and CMS requirements. Analyze and interpret data with recommendations based on judgment and experience. Perform 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. Mentor less experienced associates. Prepare and perform supervisory review of cost report desk reviews and audits. Review complex exception requests and CMS change requests. Supervise workload involving complex areas of Medicare PartA reimbursement such as DSH, Bad Debts, Medical Education, Nursing and Allied Health, Organ Acquisition, Wage Index, and cost-based principles. Perform supervisory review of cost report acceptance, interim rate reviews, tentative settlements, final settlements, and reopenings. Manage caseload of Medicare cost report appeals, position papers, jurisdictional reviews, PRRB hearings, administrative resolutions, and CMS requests. Monitor all communications related to caseload. Maintain accurate records by updating logs, case files, and tracking systems. Minimum Requirements BA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience (or equivalent combination). Foreign national applicants must meet the residency requirement of living in the United States for at least three of the past five years (CMS TDL190275). Preferred Skills, Capabilities, and Experiences Accounting degree preferred. Knowledge of CMS program regulations and cost report format preferred. Strong knowledge of CMS computer systems and Microsoft Office Word and Excel preferred. MBA, CPA, CIA, or CFE preferred. Demonstrated leadership experience preferred. Must obtain Continuing Education Training requirements. Valid driver’s license and ability to travel may be required. Additional Notes If assigned to a Government Business Division entity, the applicant and incumbent will be considered a ‘sensitive position’ and subject to additional requirements such as more frequent background checks, segregation of duties principles, role‑specific training, and sensitive data handling instructions. Salary and Benefits Salary: Audit & Reimbursement Senior$75,696 to $125,496. Locations: Maine; Maryland; Massachusetts; New York; Virginia. Benefits are consistent with those offered to Audit & Reimbursement III, including a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, medical, dental, vision, short- and long‑term disability benefits, and other benefits subject to eligibility. #J-18808-Ljbffr Wellpoint Federal Solutions, Inc.