Audit & Reimbursement Lead - Appeals

Elevance Health•Indianapolis, IN

1d•$87,120 - $137,214•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 Lead - Appeals is responsible for providing technical direction, workload planning, associate mentoring and operational support on a day-to-day basis.

Requirements

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 to meet the residency requirement of living in the United States for at least three of the past five years.

Nice To Haves

Accounting degree preferred.
Experience in software used to file and finalize cost reports and experience with paperless audit software applications preferred.
Demonstrated leadership experience; through 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, CIA or CFE preferred.

Responsibilities

Reviews work of the associates to ensure they are following the appropriate guidelines, provides training both in a formal and informal setting, reviews the policies and procedures to make sure they are appropriate, and monitors workload inventory to ensure timely completion.
Handles complex case research and resolutions.
Will support the Appeal Unit with appeal issues as assigned.
Participates in special projects and review of work done by lower level auditors.
Analyzes and interprets data and makes recommendations for change based on their judgment and experience.
Able to work independently on assignments and under minimal guidance from the manager.
Monitors inventory to ensure workflow remains uninterrupted.
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.
Assists in ISO and NASBA certification activities.
Associates in this role are expected to maintain continuing education requirements.