Audit & Reimbursement Senior - Appeals

Elevance Health; Miami (FL); Remote; USD 73,000 - 123,000; Full time

Job summary

A healthcare organization is seeking an Audit & Reimbursement Senior-Appeals. This role involves evaluating provider reimbursement, mentoring associates, and requires at least 8 years of audit/reimbursement experience. Candidates can work virtually but must attend in-person training sessions. A BA/BS degree is required, with preferred qualifications in accounting and advanced certifications. The salary range is $73,720 to $122,220.

Qualifications

• 8 years minimum in audit/reimbursement or related Medicare experience.
• Accounting degree preferred.
• Must obtain Continuing Education Training requirements.

Responsibilities

• Evaluate associate work for accurate provider reimbursement.
• Assist in training and development of associates.
• Analyze data and prepare detailed work papers according to standards.

Skills

Audit/reimbursement experience

Analysis and interpretation of data

Mentoring skills

Knowledge of CMS regulations

Microsoft Office skills

Leadership experience

Education

BA/BS in a relevant field

Accounting degree (preferred)

MBA, CPA, CIA or CFE (preferred)

Tools

Microsoft Office Excel

Microsoft Office Word

Job description

Audit & Reimbursement Senior-Appeals

Location

Work virtually full‑time with required in‑person training sessions. Candidates must be within a reasonable commuting distance unless granted lawful accommodation.

How you will make an impact

• Evaluate associate work to ensure accurate provider reimbursement.
• Assist Audit & Reimbursement Leads and Managers in training and development of associates.
• Participate in special projects as assigned.
• Work independently on assignments with minimal manager guidance.
• 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 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.
• Perform supervisory review of workload involving complex areas of Medicare Part A reimbursement such as Medicare DSH, Bad Debts, Medical Education, Nursing and Allied Health, Organ Acquisition, Wage Index and all cost‑based principles.
• Prepare and perform supervisory review of cost report reopenings.
• Manage caseload of Medicare cost report appeals.
• Position papers, jurisdictional reviews, PRRB hearings, administrative resolutions, PRRB or CMS requests, monitor all communications related to caseload, maintain accurate records by updating all logs, case files, tracking systems.

Minimum Requirements

• BA/BS and minimum 8 years of audit/reimbursement or related Medicare experience; or equivalent background.
• Foreign national applicants must meet residency requirement of living in the United States at least three of the past five years.

Preferred Skills, Capabilities and Experiences

• 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 ability to travel may be required.

Salary range: $73,720 to $122,220.

Locations: Maryland, Minnesota, Nevada and New York.

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.