Audit & Reimbursement III (US)

Elevance Health; Columbus (GA); Remote; USD 61,000 - 103,000; Full time

Job summary

A leading healthcare company is seeking an Audit & Reimbursement III to conduct audits and reviews with remote flexibility. Candidates need a BA/BS degree and at least 5 years of Medicare-related experience. The role involves leading audits and completing settlements. Preferred candidates will have accounting qualifications and knowledge of CMS programs. Competitive benefits offered.

Benefits

Comprehensive health coverage

Stock purchase plans

401(k) contributions

Incentive programs

Qualifications

• 5+ years of audit/reimbursement or related Medicare experience.
• Experience with CMS program regulations preferred.
• Must have valid driver's license.

Responsibilities

• Plans and directs specific provider audits.
• Acts as lead auditor on complex audits.
• Completes interim rate reviews and final settlements.

Skills

Audit/reimbursement experience

Analytical skills

Leadership

Communication

Education

BA/BS degree

Degree in Accounting (preferred)

MBA, CPA, or CIA (preferred)

Tools

Microsoft Office (Word and Excel)

CMS computer systems

Job description

Anticipated End Date: 2025-08-27

Position Title: Audit & Reimbursement III (US)

Job Description:

Audit & Reimbursement III

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.

National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

The Audit & Reimbursement III is responsible for completing limited and full desk reviews on teaching, organ acquisition hospitals, and other complex provider cost reports.

How you will make an impact:

• Plans, directs, and controls specific provider audits.
• Acts as the lead auditor on large and/or complex field audits.
• Responsible for assigning, reviewing, and approving the work performed by auditors on team audits.
• Completes interim rate reviews, final settlements, and tentative settlements as assigned.
• Supports the Appeal Unit with appeal issues as assigned.
• Participates in special projects and reviews work done by lower-level auditors as assigned.
• Performs complex calculations related to payment exception requests and reviews exception workpapers prepared by others.
• Analyzes and interprets data, making recommendations for change based on judgment and experience.
• May perform Part A provider enrollment responsibilities as needed.
• Associates in this role are expected to maintain continuing education requirements.

Minimum Requirements:

• Requires a BA/BS degree and at least 5 years of audit/reimbursement or related Medicare experience; or equivalent combination of education and experience.
• This position is part of our NGS division, which requires foreign national applicants to have resided in the U.S. for at least three of the past five years, per CMS TDL 190275.

Preferred Skills, Capabilities, and Experiences:

• Degree in Accounting preferred.
• 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, or CIA preferred.
• Valid driver’s license and ability to travel to worksites and other locations as necessary.

For candidates working in Maryland, Minnesota, Nevada, or New York, the salary range is $61,560 to $102,060.

Elevance Health offers benefits such as comprehensive health coverage, incentive and recognition programs, stock purchase plans, and 401(k) contributions, among others. Salary offers are based on various legitimate, non-discriminatory factors, including geographic location, experience, education, and skills.

This role may be designated as a 'sensitive position' within Government Business Divisions, requiring additional background checks, clearances, and adherence to division-specific policies.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: AFA > Audit, Compensation & Risk

Elevance Health only accepts resumes from agencies with a signed agreement. Unsolicited resumes are the property of Elevance Health.

Who We Are:

Elevance Health is committed to improving lives and communities, with a focus on making healthcare simpler. We are a Fortune 25 company with a rich history in healthcare, seeking passionate leaders at all levels.

How We Work:

Our culture promotes personal and professional growth, driven by core values and behaviors that support our strategy and business outcomes. We offer competitive total rewards, including merit increases, paid time off, insurance benefits, 401(k) match, stock plans, and wellness programs.

Our hybrid work strategy requires associates to work onsite at least once per week unless specified otherwise. Specific onsite requirements will be discussed during hiring.

We prioritize the health of our associates and communities, requiring certain roles to be vaccinated against COVID-19 and Influenza, unless an accommodation is provided. We are an Equal Employment Opportunity employer, and all qualified applicants will receive consideration without regard to protected categories. Accommodation requests can be directed to [e-mail].