Audit & Reimbursement III and Senior

Elevance Health•Durham, NC

3d•$63,156 - $125,496•Remote

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 the federal government, focusing on Medicare cost reports and Medicare Part A reimbursement. The positions offer opportunities to build auditing and financial analysis experience, participate in special projects, pursue education leading to certifications, and engage in professional networking. The roles are virtually full-time, with in-person training sessions required. Candidates must live within reasonable commuting distance of a posting location unless an accommodation is granted. Alternate locations may be considered for candidates within commuting distance of an office. The Audit & Reimbursement III works under guided supervision on complex issues and may review work, mentor less experienced associates, and—depending on experience—perform supervisory reviews. The Senior handles complex contractual workload, evaluates and supervises other associates’ work, supports training and development, and manages a caseload of Medicare cost report appeals. The III role requires a bachelor’s degree and at least three years of audit/reimbursement or related Medicare experience, or an equivalent combination of education and experience. The Senior role requires a bachelor’s degree and at least five years of relevant experience, or an equivalent combination. Both roles have a Wellpoint Federal residency requirement for foreign national applicants: living in the United States for at least three of the past five years. Salary ranges for the listed locations are $63,156–$104,706 for Audit & Reimbursement III and $75,696–$125,496 for Audit & Reimbursement Senior.

Requirements

Bachelor’s degree (BA/BS) and at least 3 years of audit/reimbursement or related Medicare experience for Audit & Reimbursement III, or an equivalent combination of education and experience.
Bachelor’s degree (BA/BS) and at least 5 years of audit/reimbursement or related Medicare experience for Audit & Reimbursement Senior, 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, per the stated Wellpoint Federal requirement.
Obtain required Continuing Education Training where applicable; the Senior posting states this requirement without qualification.
A valid driver’s license and ability to travel may be required.
Senior applicants may be subject to additional sensitive-position requirements if assigned to a Government Business Division entity, including more stringent or frequent background checks and/or government clearances, role-specific training, monitoring, segregation of duties, and sensitive-data handling instructions.

Nice To Haves

Accounting degree preferred; the III posting specifies a degree in Accounting, while the Senior posting specifies an Accounting degree.
Knowledge of CMS program regulations and cost report format.
Knowledge of CMS computer systems and Microsoft Office Word and Excel.
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, making recommendations based on judgment and experience.
Work independently on assignments with minimal guidance from a manager.
Prepare detailed work papers and present findings according to Government Auditing Standards and CMS requirements.
Respond to customer inquiries accurately and promptly.
Prioritize and manage multiple assignments using time-management, project-management, initiative, and problem-solving skills.
Perform duties of lower-level positions as directed by management.
Participate in special projects and team, staff, and training meetings.
Perform complex Medicare cost report desk reviews and audits; for the III role, serve as an in-charge auditor on assigned audits.
Review other auditors’ work, mentor less experienced associates, and, depending on experience, perform supervisory review of associates’ work.
Analyze provider trial balances, financial statements, financial documents, and other healthcare records.
Perform cost report acceptance, interim rate reviews, final settlements, tentative settlements, and reopenings as assigned.
Perform complex calculations for payment exception requests and review exception-request work papers prepared by others.
Participate under guided supervision in complex appeals work, including position papers and jurisdictional reviews.
Maintain accurate logs, case files, tracking systems, and other records.
Evaluate associates’ work to ensure accurate reimbursement to providers.
Assist Audit & Reimbursement Leads and Managers with training and associate development.
Participate in developing and maintaining Audit & Reimbursement standard operating procedures and in workgroup initiatives to improve quality, efficiency, and training.
Prepare and perform supervisory reviews of cost report desk reviews, audits, cost report acceptance, interim rate reviews, tentative settlements, final settlements, and reopenings.
Review complex exception requests and CMS change requests.
Perform supervisory reviews of complex Medicare Part A reimbursement areas, including Medicare DSH, bad debts, medical education, nursing and allied health, organ acquisition, wage index, and cost-based principles.
Manage a Medicare cost report appeals caseload, including position papers, jurisdictional reviews, PRRB hearings, administrative resolutions, PRRB or CMS requests, and related communications.