Anticipated End Date:

Position Title:

Audit & Reimbursement Sr

Job Description:

Location:  Primarily work from home; will come onsite (Pulse Point) for onboarding, training, or as otherwise required by managers

Shift: Monday-Friday 8:30am-5:00pm

Responsible for coordinating all activities of an audit or reimbursement team in the initiation and completion of assignments which includes acceptance, tentative settlements, interim rate reviews, completion of the desk audit review, field audit or in-house audit, and the settlement process of the CMS cost reports.

Primary duties may include, but are not limited to:

Perform audit work on complex audits. Evaluate the work performed by the audit staff to assess the technical accuracy and accuracy of work papers and financial data related to the cost report.Review of wage index, MSP audits, complex exception requests and CMS change requests.Assist the leads and managers in training and development of the staff on current CMS regulations.Will support the Appeal Unit with appeal issues as assigned. Participates in special projects and review of work done by lower level auditors as assign.Analyzes and interprets data and makes recommendations for change based on their judgment and experience.Provides oversight and leadership of the Part A provider enrollment function as needed.

Minimum Requirements:

a BA/BS and a minimum of 8 years of audit/reimbursement or related Medicare experience; or any combination of education and experience which would provide an equivalent background.Must obtain Continuing Education Training requirements.

Preferred Skills, Capabilities and Experiences:

MBA, CPA, CIA or CFE preferred. Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.Knowledge of CMS program regulations and cost report format preferred.Accounting degree preferred.Demonstrated leadership experience preferred.A valid driver's license and the ability to travel may be required.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

AFA > Audit, Comp & Risk

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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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. 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 elevancehealthjobssupport@elevancehealth.com for assistance.