Audit & Reimbursement III - Training

Elevance Health; Woodlawn (MD); Hybrid; USD 66,000 - 105,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Job summary

Elevance Health's Wellpoint Federal division seeks an Audit & Reimbursement III - Training professional to design and deliver audit training for providers and staff, including limited or full desk reviews. This role blends virtual instruction with hands-on practice.

You will create course content, facilitate sessions, review audit work, and stay current with CMS regulations. A BA/BS and 3+ years audit experience are required, with residency within the United States.

Qualifications

• Requires a BA/BS degree and a minimum of 3 years of audit/reimbursement or related Medicare experience.
• Residency within the United States for the past 3 of 5 years is required.

Responsibilities

• Design, deliver, and continuously improve audit training for hospital and non-hospital providers.
• Create course content and exercises aligned with current audit practices.
• Facilitate instructor-led training in a virtual environment.
• Plan and direct provider audits; act as in-charge auditor on large or complex audits.
• Review and approve work performed by auditors on team projects.
• Analyze data and make recommendations based on judgment and experience.
• Maintain continuing education requirements for associates.

Skills

Training delivery

Audit/reimbursement experience

Data interpretation

Virtual training

Education

BA/BS degree

MBA

CPA

CIA

Tools

HFS (CMS system)

MS Word

PowerPoint

Excel

Job description

Audit & Reimbursement III - Training

Location : 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.

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 III is responsible for designing, delivering, and continuously improving audit training that helps the department staff develop skills necessary to complete limited or full desk reviews on both hospital and non-hospital providers.

How you will make an impact:

• Works with audit leaders to spot skill gaps and prioritize topics to train on.

• Create course content and exercises; ensuring examples and guidance are relevant to current audit practice.

• Facilitate training sessions using audit experience to demonstrate processes and procedures.

• Plans, directs and controls specific provider audits. In charge auditor on large and/or complex field audits.

• Responsible for reviewing, and approving the work performed by auditors on team audits.

• Participates in special projects and review of work done by lower level auditors as assigned .

• Analyzes and interprets data and makes recommendations for change based on judgment and experience.

• Associates in this role are expected to maintain continuing education requirements.

Minimum Requirements:

• Requires a BA/BS degree and a minimum of 3 years of audit/reimbursement or related Medicare experience; 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 meet the residency requirement of living in the United States at least three of the past five years.

Preferred Skills, Capabilities and Experiences:

• Experience delivering engaging, instructor-led training in a virtual environment preferred.

• Working knowledge of HFS (CMS computer system) and Microsoft Office Word. PowerPoint and Excel strongly preferred.

• Degree in Accounting preferred. Knowledge of CMS program regulations and cost report format preferred.

• MBA, CPA or CIA preferred.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $66,480 to $104,706

Locations: Maine; Maryland; Massachusetts; New York

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form (https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).