Audit & Reimbursement III and Senior

Audit & Reimbursement III

Location: This role enables associates to work virtually full-time, except for 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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 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.

Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government. Under guided supervision, the award 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.

• 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.
• Perform complex cost report desk reviews.
• Perform complex cost report audits, serving as an in‑charge auditor assisting other auditors assigned to the audit.
• 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.
• Perform cost report acceptance, interim rate reviews, final settlements and tentative settlements as assigned.
• 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 papers
  • Jurisdictional reviews
  • Maintaining accurate records by updating all logs, case files, tracking systems
  • Participate in all team meetings, staff meetings, and training sessions

• 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.

• 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).
• A valid driver’s license and the ability to travel may be required.

Location: This role enables associates to work virtually full-time, except for required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration,…