Audit & Reimbursement Senior- Appeals

Anticipated End Date:

2025-06-30

Position Title:

Audit & Reimbursement Senior- Appeals

Job Description:

Audit & Reimbursement Senior

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

The Audit and Reimbursement Senior will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services).   The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A reimbursement.  This position provides a valuable opportunity to gain advanced experience in auditing and financial analysis within a growing healthcare industry. This position allows for educational opportunities leading to certifications and promotes a well-balanced lifestyle that includes professional networking opportunities.  

How you will make an impact:

• Evaluate the work performed by other associates to ensure accurate reimbursement to providers.
• Assist Audit and Reimbursement Leads and Managers in training, and development of other associates.
• Participates in special projects as assigned.
• Able to work independently on assignments and under minimal guidance from the manager.
• 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.
• 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 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
  • Maintaining accurate records by updating all logs, case files, tracking systems

Minimum Requirements:

• Requires a BA/BS and a minimum of 8 years of audit/reimbursement or related Medicare experience; or any combination of education and experience which would provide an equivalent background.
• This position is part of our NGS (National Government Services) 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.

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 the ability to travel may be required.

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.  Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.  Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Governm