Audit & Reimbursement Lead - Wellpoint Federal

Elevance Health•Cincinnati, OH

4d•$82,764 - $137,214•Remote

About The Position

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 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.
Extensive knowledge of CMS principles, law and regulations
Foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Nice To Haves

Degree in Accounting or other Business Related degree
Knowledge of CMS program regulations and cost report format, and CMS computer systems.
Knowledge of Microsoft Word and Excel
Must possess effective verbal and written communication skills
Effective organization and time management skills
Effective problem-solving skills
Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization
Experience in software used to file and finalize cost reports and experience with paperless audit software applications
Demonstrated leadership experience; thorough knowledge of CMS program regulations and cost report format
A valid driver's license and the ability to travel may be required

Responsibilities

Reviews work of the associates to ensure they follow 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 in special projects as needed
Perform supervisory review of cost report desk reviews and audits
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