Senior Auditor and Medicare Reimbursement Specialist

4 days ago


Waukesha, Wisconsin, United States Elevance Health Full time

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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