Audit & Reimbursement III - Training

Audit & Reimbursement III - Training

Location :
This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Wellpoint Federal , a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations.

The Audit & Reimbursement III is responsible for designing, delivering, and continuously improving audit training that helps the department staff develop skills necessary to complete limited or full desk reviews on both hospital and non-hospital providers.

• Works with audit leaders to spot skill gaps and prioritize topics to train on.

• Create course content and exercises; ensuring examples and guidance are relevant to current audit practice.

• Facilitate training sessions using audit experience to demonstrate processes and procedures.

• Plans, directs and controls specific provider audits. In charge auditor on large and/or complex field audits.

• Responsible for reviewing, and approving the work performed by auditors on team audits.

• Participates in special projects and review of work done by lower level auditors as assigned .

• Analyzes and interprets data and makes recommendations for change based on judgment and experience.

• Associates in this role are expected to maintain continuing education requirements.

• Requires a BA/BS degree and a minimum of 3 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 Wellpoint Federal 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.

• Experience delivering engaging, instructor-led training in a virtual environment preferred.

• Working knowledge of HFS (CMS computer system) and Microsoft Office Word. PowerPoint and Excel strongly preferred.

• Degree in Accounting preferred. Knowledge of CMS program regulations and cost report format preferred.

• MBA, CPA or CIA preferred.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.

Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $66,480 to $104,706

Locations:
Maine;
Maryland;
Massachusetts;
New York

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as…