Audit and Reimbursement Specialist

Audit and Reimbursement Specialist

This role offers remote work flexibility, allowing associates to work virtually full-time with required in-person training sessions. This setup enhances productivity and supports a healthy work-life balance while ensuring effective onboarding and skill development. Candidates should be within a commutable distance from an office.

Wellpoint Federal is a proud member of Elevance Health's family of brands, dedicated to administering government contracts for Medicare in partnership with the Centers for Medicare and Medicaid Services.

The Audit and Reimbursement Specialist will play a crucial role in our Medicare Administrative Contract (MAC) with the federal government. Under guidance, you will engage with complex issues related to the Medicare cost report and Medicare Part A reimbursement. This position offers a fantastic opportunity for growth through auditing and financial analysis while fostering professional development and networking.

Your impact in this role will include:

• Analyzing and interpreting data to recommend changes based on your judgment and experience.
• Working independently on assignments with minimal oversight from your manager.
• Preparing detailed work papers and presenting findings in compliance with Government Auditing Standards (GAS) and CMS requirements.
• Gaining insights into Federal Laws, regulations, policies, and audit procedures.
• Responding accurately and promptly to customer inquiries.
• Effectively prioritizing multiple tasks through strong time management, initiative, project management, and problem-solving skills.
• Performing duties of lower-level positions as directed by management.
• Contributing to special projects and reviewing work completed by auditors as needed.
• Mentoring less experienced associates.
• Conducting complex cost report desk reviews and audits, including serving as a lead auditor.
• Depending on your experience, performing supervisory reviews of other associates’ work.
• Anayzing provider trial balances, financial statements, and healthcare records.
• Executing cost report acceptances, interim rate reviews, and final settlements.
• Calculating payment exception requests and reviewing related work papers.
• Handling cost report reopenings.
• Participating in complex appeals under guided supervision, including preparing position papers and maintaining accurate records.
• Participating in team and training meetings.

Minimum requirements include:

• A BA/BS degree and a minimum of 3 years of audit/reimbursement or related Medicare experience, or a relevant combination of education and experience.
• This position is part of our Wellpoint Federal division requiring foreign national applicants to meet residency requirements of residing in the United States for at least three of the last five years.

Preferred Skills and Qualifications:

• Accounting degree preferred.
• Familiarity with CMS program regulations and cost report formats.
• Proficiency in CMS computer systems and Microsoft Office applications, especially Excel and Word.
• Higher qualifications such as an MBA, CPA, or CIA are preferred.
• Commitment to ongoing professional education and training.
• A valid driver's license and willingness to travel as needed.

If this position falls under any Government Business Division entity, please be aware of the additional requirements related to sensitive positions which may include more stringent background checks and specific training directives.

Elevance Health is an equal opportunity employer, ensuring all qualified applicants receive consideration for employment without discrimination. Those needing accommodation for the job application process should reach out for assistance.