Audit & Reimbursement II

Elevance Health•Atlanta, IN

2d•Remote

About The Position

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 II responsible for completing limited and full desk reviews on providers as assigned.

Requirements

Requires a BA/BS degree in Finance/Accounting/Business or any combination of education and related 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 to meet the residency requirement of living in the United States for at least three of the past five years.

Nice To Haves

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.

Responsibilities

Performs audit work scoped by the desk reviews and will be the in-charge auditor on small and less complex audits.
Assists higher level auditor on field work and appeals as assigned.
Responsible for completing interim rate reviews, tentative settlements and final settlements of providers as assigned.
Performs special audits of End Stage Renal Disease (ESRD) providers and provider exception requests as assigned.
Updates STAR, FISS and PSF as assigned.
Participates as a team member on audits of provider's records and other projects.
Analyzes and interprets data and makes recommendations for change based on their judgment and experience.
May perform Part A provider enrollment responsibilities as needed.
Associates in this role are expected to maintain continuing education requirements