Elevance Health
Audit & Reimbursement Lead
Elevance Health, Wilmington, Delaware, us, 19894
Elevance Health - Audit & Reimbursement Lead - Wilmington, Delaware
This is a United States, virtual-based position.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 Lead
will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division within the Department of Health and Human Services). Under the direction of management, the Audit and Reimbursement Lead will provide technical leadership, supervision, and coordination on contractual workload involving the Medicare cost report and Medicare Part A reimbursement. This position provides a valuable opportunity to lead team members performing auditing and financial analysis within a growing healthcare industry.How you will make an impact:Reviews work of the associates to ensure they are following the appropriate guidelines.Provides training/mentoring both in a formal and informal setting.Monitors workload inventory to ensure timely completion.Handles complex case research and resolutions.Assists management with workload and financial budget responsibilities.Must have extensive knowledge of CMS principles, law, and regulations.Works with management on interaction with internal and external audits and performance measures.Assist management on monitoring and training lower-level staff.Analyze and interpret data with recommendations based on judgment and experience.Must be able to perform all duties of lower-level positions as directed by management.Participate in the development and maintenance of Audit & Reimbursement standard operating procedures.Participate in workgroup initiatives to enhance quality, efficiency, and training.Participate on special projects as needed.Perform supervisory review of cost report desk reviews and audits.Perform supervisory review on complex areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition, Wage Index, and all cost-based principles.Minimum Qualifications:Requires a BA/BS degree and a minimum of 8 years audit/reimbursement or related Medicare experience which includes previous experience at a Senior Auditor level in health care, public accounting, or a government agency; or any combination of education and experience, which would provide an equivalent background.Preferred Skills, Capabilities, and Experiences:Experience in software used to file and finalize cost reports and experience with paperless audit software applications preferred.Demonstrated leadership experience; thorough 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, CIA, or CFE preferred.Must obtain Continuing Education Training requirements (where required).For candidates working in person or remotely in the below location(s), the salary range for this specific position is $86,320 to $135,954.In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. 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.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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This is a United States, virtual-based position.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 Lead
will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division within the Department of Health and Human Services). Under the direction of management, the Audit and Reimbursement Lead will provide technical leadership, supervision, and coordination on contractual workload involving the Medicare cost report and Medicare Part A reimbursement. This position provides a valuable opportunity to lead team members performing auditing and financial analysis within a growing healthcare industry.How you will make an impact:Reviews work of the associates to ensure they are following the appropriate guidelines.Provides training/mentoring both in a formal and informal setting.Monitors workload inventory to ensure timely completion.Handles complex case research and resolutions.Assists management with workload and financial budget responsibilities.Must have extensive knowledge of CMS principles, law, and regulations.Works with management on interaction with internal and external audits and performance measures.Assist management on monitoring and training lower-level staff.Analyze and interpret data with recommendations based on judgment and experience.Must be able to perform all duties of lower-level positions as directed by management.Participate in the development and maintenance of Audit & Reimbursement standard operating procedures.Participate in workgroup initiatives to enhance quality, efficiency, and training.Participate on special projects as needed.Perform supervisory review of cost report desk reviews and audits.Perform supervisory review on complex areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition, Wage Index, and all cost-based principles.Minimum Qualifications:Requires a BA/BS degree and a minimum of 8 years audit/reimbursement or related Medicare experience which includes previous experience at a Senior Auditor level in health care, public accounting, or a government agency; or any combination of education and experience, which would provide an equivalent background.Preferred Skills, Capabilities, and Experiences:Experience in software used to file and finalize cost reports and experience with paperless audit software applications preferred.Demonstrated leadership experience; thorough 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, CIA, or CFE preferred.Must obtain Continuing Education Training requirements (where required).For candidates working in person or remotely in the below location(s), the salary range for this specific position is $86,320 to $135,954.In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. 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.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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