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Audit & Reimbursement Senior- Appeals Specialist
2 months ago
We are seeking a highly skilled Audit & Reimbursement Senior- Appeals Specialist to join our team at Elevance Health. As a key member of our team, you will play a critical role in ensuring accurate reimbursement to healthcare providers.
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.
- 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 supervisory review of workload involving complex areas of Medicare part A reimbursement.
- Manage caseload of Medicare cost report Appeals.
- Requires a BA/BS and a minimum of 8 years of audit/reimbursement or related Medicare experience.
- 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.
- Accounting degree preferred.
- 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.
- MBA, CPA, CIA or CFE preferred.
- Demonstrated leadership experience preferred.
Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
What We Offer- A comprehensive benefits package.
- Incentive and recognition programs.
- Equity stock purchase and 401(k) contribution.
- Market-competitive total rewards.
