Audit & Reimbursement III (US)

Elevance Health; West Des Moines (IA); Remote; USD 61,000 - 103,000; Full time

Job summary

A leading health company is seeking an Audit & Reimbursement III to perform complex audits and ensure compliance within Medicare programs. This role allows for full-time virtual work, with responsibilities including leading audits and reviewing work performed by auditors. Candidates should have at least 5 years of relevant experience and a BA/BS degree. Comprehensive benefits including health coverage are offered.

Benefits

Comprehensive health coverage

401(k) and stock purchase plan

Incentive programs

Qualifications

• 5 years of audit/reimbursement or related Medicare experience, or equivalent.
• Must meet residency requirements of living in the U.S. for 3 of the last 5 years.

Responsibilities

• Plans, directs, and controls specific provider audits.
• Acts as the lead auditor on large complex field audits.
• Completes interim and final settlements as assigned.

Skills

Audit/reimbursement experience

Analytical skills

Knowledge of CMS program regulations

Proficiency in Microsoft Office

Education

BA/BS degree

Degree in Accounting

Tools

Microsoft 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 position 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.
• Assigns, reviews, and approves 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.
• Performs complex calculations related to payment exception requests and reviews related workpapers.
• Analyzes and interprets data and makes recommendations for change based on judgment and experience.
• May perform Part A provider enrollment responsibilities as needed.
• Maintains continuing education requirements.

Minimum Requirements:

• Requires a BA/BS degree and at least 5 years of audit/reimbursement or related Medicare experience, or an equivalent combination of education and experience.
• Must meet residency requirements of living in the United States at least three of the past five years, as per CMS TDL 190275.

Preferred Skills, Capabilities, and Experiences:

• Degree in Accounting preferred.
• Knowledge of CMS program regulations and cost report formats 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 as necessary.

Salary range for candidates working in Maryland, Minnesota, Nevada, and New York: $61,560 to $102,060.

Additional benefits include comprehensive health coverage, incentive programs, 401(k), stock purchase plan, and more. Compensation offers are based on various factors including location, experience, education, and skills.

Roles in Government Business Divisions may require additional security clearances and compliance with specific policies.

Job Level: Non-Management Exempt

Work Shift: 1st Shift (United States of America)

Job Family: AFA > Audit, Compliance & Risk

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

Who We Are:

Elevance Health is committed to improving lives and communities, and fostering a culture of growth and shared success.

How We Work:

We offer competitive rewards, promote a hybrid work environment, and prioritize the health and safety of our associates, including COVID-19 and Influenza vaccinations where required.

We are an Equal Opportunity Employer, considering all qualified applicants without discrimination. For accommodations during the application process, contact [e-mail].