Audit & Reimbursement III and Senior

Elevance Health•Durham, NC

4d•$63,156 - $125,496•Hybrid

About The Position

Wellpoint Federal, part of Elevance Health, administers government Medicare contracts and partners with the Centers for Medicare and Medicaid Services (CMS). The Audit & Reimbursement III and Senior roles support the Medicare Administrative Contract (MAC) with CMS, focusing on Medicare cost reports and Medicare Part A reimbursement. The positions provide opportunities to develop auditing and financial analysis expertise, participate in contractual workload and special projects, pursue education leading to certifications, and build professional networks. Both roles are virtually full-time, with in-person training required. Candidates must live within a reasonable commuting distance of a listed office location unless an accommodation is granted. Alternate locations may be considered for candidates within commuting distance. The roles are part of Wellpoint Federal and require foreign national applicants to have lived in the United States for at least three of the past five years. Government Business Division assignments may also involve additional background checks or clearances, role-specific training, monitoring, segregation-of-duties practices, and sensitive-data handling requirements. The Audit & Reimbursement III works under guided supervision on increasingly complex Medicare cost report and reimbursement matters, including desk reviews, audits, settlements, exception requests, reopenings, and appeals-related work. The role may serve as an in-charge auditor, review other auditors’ work, and mentor less experienced associates. The Audit & Reimbursement Senior handles complex Medicare cost report and Part A reimbursement workload, evaluates other associates’ work, and supports training and development. The role performs supervisory reviews across audits, desk reviews, exceptions, settlements, reopenings, and complex reimbursement matters. It also manages Medicare cost report appeals, including related filings, hearings, requests, communications, and records. The posted salary ranges are $63,156–$104,706 for Audit & Reimbursement III and $75,696–$125,496 for Audit & Reimbursement Senior in Maine, Maryland, Massachusetts, New York, and Virginia. Compensation depends on factors including location, experience, education, and skills. Elevance Health states that it offers a comprehensive benefits package, subject to eligibility requirements.

Requirements

Audit & Reimbursement III: BA/BS degree and at least 3 years of audit/reimbursement or related Medicare experience, or an equivalent combination of education and experience.
Audit & Reimbursement Senior: BA/BS degree and at least 5 years of audit/reimbursement or related Medicare experience, or an equivalent combination of education and experience.
Foreign national applicants must have lived in the United States for at least three of the past five years.
Must obtain required Continuing Education Training where applicable; the Senior listing states this requirement without qualification.
Ability to work independently, analyze and interpret data, prioritize workload, and communicate findings clearly.
A valid driver's license and ability to travel may be required.
Applicants assigned to a Government Business Division entity may be subject to additional background checks or government clearances, role-specific training, monitoring, segregation-of-duties principles, and sensitive-data handling requirements.

Nice To Haves

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.
MBA, CPA, or CIA preferred for Audit & Reimbursement III.
MBA, CPA, CIA, or CFE preferred for Audit & Reimbursement Senior.
Demonstrated leadership experience preferred for Audit & Reimbursement Senior.

Responsibilities

Analyze and interpret data, make recommendations based on judgment and experience, and work independently with minimal manager guidance.
Prepare detailed work papers and present findings in accordance with Government Auditing Standards and CMS requirements.
Respond accurately and promptly to customer inquiries and manage competing priorities using time-management, project-management, initiative, and problem-solving skills.
Perform complex Medicare cost report desk reviews and audits, including serving as an in-charge auditor and assisting other assigned auditors.
Review other associates’ work and, depending on experience or role, perform supervisory reviews of audits, desk reviews, exceptions, and other reimbursement workload.
Analyze provider trial balances, financial statements, financial documents, and other healthcare records.
Perform cost report acceptance, interim rate reviews, tentative settlements, final settlements, and reopenings.
Perform complex calculations for payment exception requests and review exception-request work papers prepared by others.
Participate in appeals-related work, including position papers and jurisdictional reviews; for the Senior role, manage appeals caseloads involving PRRB hearings, administrative resolutions, PRRB or CMS requests, and related communications.
Maintain accurate logs, case files, tracking systems, and other records.
Participate in special projects, team meetings, staff meetings, training sessions, and workgroup initiatives.
Assist with mentoring, training, and developing less experienced associates.
For the Senior role, participate in developing and maintaining Audit & Reimbursement standard operating procedures and initiatives to improve quality, efficiency, and training.
Perform all duties of lower-level positions as directed by management.