Audit & Reimbursement Lead

Anticipated End Date:

Position Title: Audit & Reimbursement Lead (US)

Job Description:

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.

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 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. This position allows for educational opportunities leading to certifications and promotes a well-balanced lifestyle that includes professional networking opportunities.
Responsible for providing technical direction, workload planning, associate mentoring, and operational support on a day-to-day basis.

• 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 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.

If this…