Audit & Reimbursement Specialist
2 months ago
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
- 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).
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