Senior CMS Audit & Reimbursement Lead

Elevance Health; Mason (OH); Hybrid; USD 83,000 - 137,000; Full time

Job summary

Elevance Health’s Wellpoint Federal division seeks an Audit & Reimbursement Lead to guide technical direction, workload planning, mentoring, and day-to-day operations with a strong emphasis on CMS regulations and audit experience. The role supports hybrid/virtual work with in-person onboarding and training as required.

You will oversee reviews, data analysis and recommendations, and collaborate with management on internal and external audits, cost reports, and performance measures, enabling

Qualifications

• Requires a BA/BS degree and a minimum of 8 years audit/reimbursement experience in healthcare, public accounting, or government settings.
• This role is part of Wellpoint Federal; residency within the United States is required by CMS policy.

Responsibilities

• Reviews work of associates to ensure they follow guidelines.
• Provides training/mentoring in formal and informal settings.
• Monitors workload inventory to ensure timely completion.
• Handles complex case research and resolutions.
• Assists management with workload and budget responsibilities.
• Interacts with internal and external audits and performance measures.
• Analyses data and provides recommendations based on judgment and experience.
• Participates in development and maintenance of Audit & Reimbursement SOPs.
• Performs supervisory reviews of cost reports and Medicare cost areas.
• Must travel and hold a valid driver's license.

Skills

CMS knowledge

Verbal & written comms

Leadership experience

Organizational skills

Time management

Analytical thinking

Education

BA/BS degree

Accounting degree (preferred)

Tools

CMS computer systems

Microsoft Word

Microsoft Excel

Cost report software

Paperless audit software

Job description

Elevance Health’s Wellpoint Federal division seeks an Audit & Reimbursement Lead to guide technical direction, workload planning, mentoring, and day-to-day operations with a strong emphasis on CMS regulations and audit experience. The role supports hybrid/virtual work with in-person onboarding and training as required.

You will oversee reviews, data analysis and recommendations, and collaborate with management on internal and external audits, cost reports, and performance measures, enabling