Audit & Reimbursement Senior - Appeals

Elevance Health; Winston-Salem (NC); Remote; USD 73,000 - 123,000; Full time

Job summary

A national health services company seeks an Audit & Reimbursement Senior-Appeals. Responsibilities include evaluating provider reimbursements and overseeing audits. Candidates should have 8+ years Medicare experience and a relevant degree. This role allows for virtual work, requiring occasional in-person training. The salary range is $73,720 to $122,220.

Qualifications

• 8+ years of audit/reimbursement or related Medicare experience.
• Must meet residency requirement of living in the U.S. for 3 of the last 5 years.

Responsibilities

• Evaluate associate work for accurate provider reimbursement.
• Prepare and present findings according to auditing standards.
• Assist in training and mentoring less experienced associates.

Skills

Audit experience

Medicare experience

Leadership skills

Data analysis

Education

BA/BS in relevant field

Accounting degree preferred

MBA, CPA, CIA or CFE preferred

Tools

Microsoft Office Word

Microsoft Excel

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.