Audit & Reimbursement Lead- Appeals

Elevance Health•Indianapolis, IN

18h•Remote

About The Position

The Audit & Reimbursement Lead will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division within the Department of Health and Human Services). Under direction of management, the Audit and Reimbursement Lead will provide technical leadership, supervision and coordination on contractual workload involving the Medicare cost report and Medicare Part A reimbursement. This position provides a valuable opportunity to lead team members performing 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. 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.
Must have extensive knowledge of CMS principles, law, and regulations.
This position is part of our Wellpoint Federal 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.

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.
Must obtain Continuing Education Training requirements (where required).
A valid driver's license and the ability to travel may be required.

Responsibilities

Reviews work of the associates to ensure they are following the appropriate guidelines.
Provides training/mentoring both in a formal and informal setting.
Monitors workload inventory to ensure timely completion.
Handles complex case research and resolutions.
Assists management with workload and financial budget responsibilities.
Works with management on interaction with internal and external audits and performance measures
Assist management on monitoring and training lower-level staff.
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 on special projects as needed.
Perform supervisory review on cost report appeals – position papers, jurisdiction reviews, work papers, Administrative Resolutions, and other work.
Perform supervisory review of cost report reopenings.
Perform supervisory review on complex areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition, Wage Index and all cost-based principles.