Remote CMS Audit & Reimbursement Lead

Elevance Health; Roanoke (VA); Hybrid; USD 83,000 - 137,000; Full time

Job summary

Elevation Health through Wellpoint Federal seeks an Audit & Reimbursement Lead to guide technical direction, workload planning and mentoring for a day-to-day support role in Medicare/Cost reports. This position emphasizes CMS knowledge, data interpretation and leadership within a hybrid remote framework.

Ideal candidates hold a BA/BS with 8+ years in audit or reimbursement, and can supervise complex reviews while collaborating with management on budgets and performance metrics.

Qualifications

• Requires a BA/BS degree and a minimum of 8 years audit/reimbursement or related Medicare experience which includes previous experience at a Senior Auditor level in health care, public accounting or a government agency; 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.

Responsibilities

• Reviews work of the associates to ensure they follow the appropriate guidelines
• Provides training/mentoring both in a formal and informal setting
• Monitors workload inventory to ensure timely completion
• Handles complex case research and resolutions
• Assists management with workload and financial budget responsibilities
• Must have extensive knowledge of CMS principles, law and regulations
• Works with management on interaction with internal and external audits and performance measures
• Assist management on monitoring and training lower-level staff
• Analyze and interpret data with recommendations based on judgment and experience
• Must be able to perform all 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
• Participate in special projects as needed
• Perform supervisory review of cost report desk reviews and audits
• Perform supervisory review on complex areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition, Wage Index and all cost-based principles

Skills

CMS knowledge

Data analysis

Leadership

Mentoring

Budget management

Communication skills

Travel may be required

Education

BA/BS degree

Tools

CMS systems

Microsoft Word

Excel

Job description

Elevation Health through Wellpoint Federal seeks an Audit & Reimbursement Lead to guide technical direction, workload planning and mentoring for a day-to-day support role in Medicare/Cost reports. This position emphasizes CMS knowledge, data interpretation and leadership within a hybrid remote framework.

Ideal candidates hold a BA/BS with 8+ years in audit or reimbursement, and can supervise complex reviews while collaborating with management on budgets and performance metrics.