Audit & Reimbursement Specialist III - Appeals
3 days ago
We are seeking a highly skilled Audit & Reimbursement Specialist III - Appeals to join our team at Elevance Health. As a key member of our team, you will play a critical role in supporting our Medicare Administrative Contract (MAC) with the federal government.
Key Responsibilities- Analyze and interpret complex data to make recommendations for change based on judgment and experience.
- 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.
- Perform complex cost report desk reviews.
- 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.
- 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.
- 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.
- Degree in Accounting 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).
- A valid driver's license and the ability to travel may be required.
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