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 Senior will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A reimbursement. This position provides a valuable opportunity to gain advanced experience in 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.
How you will make an impact:
Evaluate the work performed by other associates to ensure accurate reimbursement to providers specifically surrounding Worksheet S-10.
Assist Audit and Reimbursement Leads and Managers in training, and development of other associates.
Participates in special projects as assigned.
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.
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 all team meetings, staff meetings, and training sessions.
Assist in mentoring less experienced associates as assigned.
Prepare and perform supervisory review of cost report desk reviews and audits.
Review of complex exception requests and CMS change requests.
Perform supervisory review of workload involving complex areas of Medicare part A reimbursement such as Medicare DSH, Bad Debts, Medical Education, Nursing and Allied Health, Organ Acquisition, Wage Index and all cost based principles.
Minimum Requirements:
Requires a BA/BS and a minimum of 8 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 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.
Preferred Skills, Capabilities, and Experiences:
Accounting degree preferred.
Knowledge of CMS program regulations and cost report format preferred.
Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
Must obtain Continuing Education Training requirements.
MBA, CPA, CIA or CFE preferred.
Demonstrated leadership experience preferred.
A valid driver's license and the ability to travel may be required.
