[Hiring] Audit & Reimbursement II @Elevance Health

Role Description

The Audit & Reimbursement II is responsible for completing limited and full desk reviews on providers as assigned.

How you will make an impact:

• Performs audit work scoped by the desk reviews and will be the in-charge auditor on small and less complex audits.
• Assists higher level auditor on field work and appeals as assigned.
• Performs special audits of End Stage Renal Disease (ESRD) providers and provider exception requests as assigned.
• Updates STAR, FISS and PSF as assigned.
• Participates as a team member on audits of provider's records and other projects.
• Analyzes and interprets data and makes recommendations for change based on their judgment and experience.
• May perform Part A provider enrollment responsibilities as needed.
• Associates in this role are expected to maintain continuing education requirements.

Qualifications

• Requires a BA/BS degree in Finance/Accounting/Business or any combination of education and related 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 to meet the residency requirement of living in the United States for at least three of the past five years.

Requirements

• Degree in Accounting preferred.
• Knowledge of CMS program regulations and cost report format preferred.
• Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
• MBA, CPA or CIA preferred.
• If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).