Audit & Reimbursement Sr

$74,800 - $123,420/Yr

Elevance Health - Smithfield, RI

Full-time - Mid Level

Smithfield, RI

11-50 employees

Insurance Carriers and Related Activities

About the position

The Audit and Reimbursement Senior will support the Medicare Administrative Contract (MAC) with the federal government, focusing on complex Medicare cost reports and Medicare Part A reimbursement. This role offers advanced experience in auditing and financial analysis within the healthcare industry, along with opportunities for professional development and certifications.

Responsibilities

• Evaluate the work performed by other associates to ensure accurate reimbursement to providers.
• Assist Audit and Reimbursement Leads and Managers in training and development of other associates.
• Participate in special projects as assigned.
• Work independently on assignments with minimal guidance from the manager.
• Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements.
• Analyze and interpret data with recommendations based on judgment and experience.
• 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.
• Attend all team meetings, staff meetings, and training sessions.
• Assist in mentoring less experienced associates as assigned.
• Prepare and perform supervisory review of cost report desk reviews and audits.
• Perform supervisory review of workload involving complex areas of Medicare Part A reimbursement.
• Prepare and perform supervisory review of cost report acceptance, interim rate reviews, tentative settlements, and final settlements as assigned.
• Prepare and perform supervisory review of cost report reopenings.

Requirements

• BA/BS degree and a minimum of 8 years of audit/reimbursement or related Medicare experience; or equivalent combination of education and experience.
• Must meet residency requirement of living in the United States at least three of the past five years.

Nice-to-haves

• Medicare Cost Reporting experience
• 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
• Must obtain Continuing Education Training requirements
• MBA, CPA, CIA or CFE preferred
• Demonstrated leadership experience preferred
• A valid driver's license and the ability to travel may be required.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision, short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources