Audit & Reimbursement Lead - Wellpoint Federal

• Reviews work of the associates to ensure they follow 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 in special projects as needed
• Perform supervisory review of cost report desk reviews and audits
• Perform supervisory review on complex areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition, Wage Index and all cost-based principles

• 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 Wellpoint Federal 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.

• Degree in Accounting or other Business Related degree
• Knowledge of CMS program regulations and cost report format, and CMS computer systems.
• Knowledge of Microsoft Word and Excel
• Must possess effective verbal and written communication skills
• Effective organization and time management skills
• Effective problem-solving skills
• Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization
• 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

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.

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 and Influenza. 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 View email address on us.fitly.work for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act