Audit & Reimbursement Specialist

2 months ago


Louisville, Kentucky, United States Elevance Health Full time
Job Description

Audit & Reimbursement III - Medicare Cost Report Appeals

This is a virtual position; US based

National 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.

Key Responsibilities
  • 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 papersJurisdictional ReviewsMaintaining accurate records by updating all logs, case files, tracking systemsParticipate in all team meetings, staff meetings, and training sessions
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 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).


  • Louisville, Kentucky, United States Elevance Health Full time

    Audit and Reimbursement Senior RoleWe are seeking a highly skilled Audit and Reimbursement Senior to join our team at Elevance Health. As a key member of our Medicare Administrative Contract (MAC) team, you will play a critical role in supporting our contractual workload involving complex Medicare cost reports and Medicare Part A reimbursement.Key...


  • Louisville, Kentucky, United States Elevance Health Full time

    Job DescriptionAudit and Reimbursement Specialist III - Medicare Cost Report AppealsThis role supports our Medicare Administrative Contract (MAC) with the federal government, working under guided supervision to gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement.Key Responsibilities:Analyze and interpret...


  • Louisville, Kentucky, United States Actalent Full time

    Job Title:Manufacturing Engineer - Quality Assurance SpecialistJob Description:The Manufacturing Engineer - Quality Assurance Specialist will be a part of the Connected Vehicle team, supporting Infotainment, Sync, radio, speakers, amps, etc. Responsibilities include supporting warranty and in-plant meetings, investigating warranty claims, communicating with...

  • Audit Project Manager

    2 weeks ago


    Louisville, Kentucky, United States Fifth Third Bank, N.A. Full time

    Job Summary:Fifth Third Bank, N.A. is seeking a highly skilled Audit Project Manager - Regulatory Compliance to join our team. As a key member of our Internal Audit department, you will be responsible for conducting end-to-end business process audits for various business/functional areas within the Bank.Key Responsibilities:Develop and execute audit...


  • Louisville, Kentucky, United States Tolmar Full time

    Job SummaryTolmar is seeking a highly skilled Field Reimbursement Manager to join our team. As a key member of our Patient Services and Market Access team, you will be responsible for ensuring optimal access to our products for patients in the Central Region of the United States.Key ResponsibilitiesDevelop and implement effective reimbursement strategies to...


  • Louisville, Kentucky, United States JJM Marketing LLC Full time

    Solar Consultant Job DescriptionBecome a Solar Consultant with AMP SMART SOLARAre you passionate about renewable energy and eager to help others? At AMP SMART Solar, we believe in making solar energy accessible and exciting for everyone. As a Solar Consultant, you will be the friendly face that helps customers discover the numerous benefits of solar...


  • Louisville, Kentucky, United States Randstad Full time

    Job Title: Medical Accounts Receivable SpecialistWe are seeking a highly organized and detail-oriented Medical Accounts Receivable Specialist to join our team at Randstad. As a Medical Accounts Receivable Specialist, you will be responsible for assisting with audit work, handling EOBs, and processing cash transfers and check requests.Responsibilities:Assist...


  • Louisville, Kentucky, United States Norton Healthcare Full time

    Job SummaryWe are seeking a skilled Coding Auditor to join our team at Norton Healthcare. As a Coding Auditor, you will be responsible for evaluating coding based on Coding Guidelines and reviewing records for all care settings.Key ResponsibilitiesEvaluate coding based on Coding GuidelinesReview records for all care settingsIdentify high volume, high risk...


  • Louisville, Kentucky, United States Multi-Color Corporation Full time

    Quality Assurance SpecialistAt Multi-Color Corporation, we are seeking a Quality Assurance Specialist to join our team. This role will be responsible for performing quality audits, testing raw materials and products, and reporting test results as needed.The Quality Assurance Specialist will support the Manufacturing, Technical Service, Quality, Sales,...


  • Louisville, Kentucky, United States Trilogy Health Services Full time

    Payer Services Specialist Job DescriptionTrilogy Health Services is seeking a highly skilled Payer Services Specialist to join our team. As a Payer Services Specialist, you will be responsible for performing tasks related to prior authorizations, recertifications, and insurance verifications for potential admissions and therapy services.This role will report...


  • Louisville, Kentucky, United States Southern Home Care Services, Inc. Full time

    Job Title: IT Compliance SpecialistJoin our team at Southern Home Care Services, Inc. as an IT Compliance Specialist, where you will play a critical role in ensuring our IT systems and processes comply with SOX regulations and industry best practices.Job SummaryWe are seeking a highly skilled IT Compliance Specialist to develop and implement a comprehensive...


  • Louisville, Kentucky, United States Jobot Full time

    Accounts Payable SpecialistWe are seeking a highly skilled and detail-oriented Accounts Payable Specialist to join our team at Jobot. As an Accounts Payable Specialist, you will be responsible for processing high volumes of vendor invoices, corporate credit cards, check requests, and expense reports in a timely and accurate manner.Responsibilities:Process...


  • Louisville, Kentucky, United States Jobot Full time

    Accounts Payable Specialist Job DescriptionWe are seeking an experienced Accounts Payable Specialist to join our team at Jobot. As an Accounts Payable Specialist, you will be responsible for processing high volumes of vendor invoices, corporate credit cards, check requests, and expense reports in a timely and accurate manner.Key Responsibilities:Process...


  • Louisville, Kentucky, United States Restaurant Depot Full time

    Restaurant Depot - 620 Locust LaneAs a Loss Prevention Specialist at Restaurant Depot, you will be responsible for leading and conducting audits to identify trends and create actionable plans to mitigate risk. You will serve as a subject matter expert in focusing on key issues causing shrink, including improper keying of product, case/unit issues, and...


  • Louisville, Kentucky, United States Drive Line Service Full time

    Job Summary:We are seeking a Retail Merchandising Specialist to join our team. As a Retail Merchandising Specialist, you will be responsible for visiting various retail locations within a 25-mile radius of your home to audit products, count inventory, set new fixtures and displays, and perform other critical tasks.Key Responsibilities:Audit products and...


  • Louisville, Kentucky, United States Derby City Gaming, LLC Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Cash Handling Specialist to join our team at Derby City Gaming, LLC. The successful candidate will be responsible for collecting cash drop boxes from gaming machines and redemption kiosks, adhering to company count policies and procedures, and safeguarding un-audited assets in storage carts.Key...


  • Louisville, Kentucky, United States Michelin North America Full time

    Job Title: Environmental Health and Safety SpecialistWe are seeking a highly motivated and experienced Environmental Health and Safety Specialist to join our team at Michelin North America. As a key member of our EHS team, you will be responsible for providing support and direction to meet the site's safety, health, and environment objectives.Key...


  • Louisville, Kentucky, United States Jobot Full time

    Accounts Payable SpecialistWe are seeking a highly skilled Accounts Payable Specialist to join our dynamic team at Jobot. As an integral part of our financial operations, you will be responsible for processing high volumes of vendor invoices, corporate credit cards, check requests, and expense reports in a timely and accurate manner.Key...


  • Louisville, Kentucky, United States Jobot Full time

    Accounts Payable SpecialistWe are a leading firm in the construction industry, seeking an experienced Accounts Payable Specialist to join our team. This role is integral to our financial operations, ensuring accuracy, efficiency, and compliance in our accounts payable processes.Key Responsibilities:Process high volumes of vendor invoices, corporate credit...


  • Louisville, Kentucky, United States JJM Marketing Full time

    Unlock Your Potential as a Solar ConsultantBecome a Solar Consultant with AMP SMART SOLAR and embark on a rewarding career in renewable energy. As a friendly face, you'll help customers discover the numerous benefits of solar power and provide personalized consultations to suit their needs and budget.Your Key Responsibilities:Engage with potential customers...