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Audit & Reimbursement III- Medicare Cost Report AppealsLocation : This is a virtual position; US basedNational Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services). Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement. They will participate in contractual Audit and Reimbursement workload and have opportunities to participate on special projects. This position provides a valuable opportunity to gain further experience in auditing and financial analysis within a growing healthcare industry. This position allows for educational opportunities leading to certifications and promotes a well-balanced lifestyle that includes professional networking opportunities.How you will make an impact:Primary duties may include, but are not limited to:
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.
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.
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
Minimum Requirements:
Requires a BA/BS degree 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.
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 :
Degree in Accountingn preferred.
Knowledge of CMS program regulations and cost report format preferred.
Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
MBA, CPA or CIA preferred.
Must obtain Continuing Education Training requirements (where required).
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.For candidates working in person or remotely in the below location(s), the salary range for this specific position is $62,400 to $98,280Locations: Colorado; Nevada; New YorkIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.