Audit & Reimbursement Lead - Wellpoint Federal

Audit & Reimbursement Lead 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. 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 , 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 Lead is 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 follow 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 in 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 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 or other Business Related degree

• Knowledge of CMS program regulations and cost report format, and CMS computer systems.

• Knowledge of Microsoft Word and Excel

• Must possess effective verbal and written communication skills

• Effective organization and time management skills

• Effective problem-solving skills

• Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization

• Experience in software used to file and finalize cost reports and experience with paperless audit software applications

• Demonstrated leadership experience; thorough knowledge of CMS program regulations and cost report format

• A valid driver's license and the ability to travel may be required

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 $82,764 to $137,214

Locations:
Maine;
Maryland;
Massachusetts;
New York;
Virginia

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 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…