Audit & Reimbursement Lead

Audit & Reimbursement Lead

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 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, offers educational opportunities leading to certifications, and promotes a well‑balanced lifestyle that includes professional networking opportunities.

The role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy.

Location(s):
Columbus, Ohio;
New York;
Nevada;
Maryland;
Massachusetts. Salary range: $87,120 to $137,214.

Note:

Candidates must be within reasonable commuting distance of the posting location unless an accommodation is granted as required by law.

• 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 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.

• 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.
• This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States at least three of the past five years.

• Accounting degree preferred.
• Experience in software used to file and finalize cost reports and experience with paperless audit software applications preferred.
• Demonstrated leadership experience; through 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).
• A valid driver's license and the ability to travel may be required.

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.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.