Senior Auditor and Medicare Reimbursement Specialist
4 days ago
About the Role
This is a virtual position based in the United States, working with National Government Services, a proud member of Elevance Health's family of brands.
The Audit and Reimbursement Senior-Appeals will support our Medicare Administrative Contract (MAC) with the federal government, transforming federal health programs.
Key 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 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.
- 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.
- Review of complex exception requests and CMS change requests.
- Supervise workload involving complex areas of Medicare part A reimbursement.
Requirements
- BA/BS and a minimum of 8 years of audit/reimbursement or related Medicare experience.
- 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.
Preferred Skills
- Accounting degree preferred.
- Demonstrated leadership experience preferred.
- A valid driver's license and the ability to travel may be required.
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Waukesha, Wisconsin, United States Elevance Health Full timeAbout the RoleThe Audit and Reimbursement Senior - Appeals Specialist will support our Medicare Administrative Contract (MAC) with the federal government, working closely with the Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services. This position involves complex Medicare cost reports and Medicare Part A...
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