Elevance Health
Audit & Reimbursement Senior - Appeals
Elevance Health
Remote virtual full‑time with required in‑person training.
Please note that candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted as required by law.
Employment type: Full‑time; Seniority level: Mid‑Senior; Job function: Accounting/Auditing and Finance; Industries: Hospitals and Health Care.
How You Will Make An Impact
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.
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 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.
Minimum Requirements
Requires 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.
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.
Preferred Skills, Capabilities And Experiences
Accounting degree preferred.
Knowledge of CMS program regulations and cost report format preferred.
Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
Must obtain Continuing Education Training requirements.
MBA, CPA, CIA or CFE preferred.
Demonstrated leadership experience preferred.
A valid driver's license and the ability to travel may be required.
Compensation and Benefits Salary range: $73,720 to $122,220. Locations: Maryland, Minnesota, Nevada and New York.
Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (subject to eligibility requirements).
Equal Employment Opportunity 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, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable federal, state or local laws.
#J-18808-Ljbffr
Remote virtual full‑time with required in‑person training.
Please note that candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted as required by law.
Employment type: Full‑time; Seniority level: Mid‑Senior; Job function: Accounting/Auditing and Finance; Industries: Hospitals and Health Care.
How You Will Make An Impact
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.
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 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.
Minimum Requirements
Requires 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.
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.
Preferred Skills, Capabilities And Experiences
Accounting degree preferred.
Knowledge of CMS program regulations and cost report format preferred.
Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
Must obtain Continuing Education Training requirements.
MBA, CPA, CIA or CFE preferred.
Demonstrated leadership experience preferred.
A valid driver's license and the ability to travel may be required.
Compensation and Benefits Salary range: $73,720 to $122,220. Locations: Maryland, Minnesota, Nevada and New York.
Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (subject to eligibility requirements).
Equal Employment Opportunity 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, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable federal, state or local laws.
#J-18808-Ljbffr