Audit & Reimbursement III and Senior

Position: Audit & Reimbursement III & Senior – National Government Services, Elevance Health

Location: This role is fully virtual full‑time, with required in‑person training sessions. verdes?; hybrid policy applies – candidates must be within a reasonable commuting distance unless accommodation is granted asිත law.

• Analyze & interpret data, make recommendations for change based on judgment and experience.
• Work independently on assignments with minimal guidance; respond promptly to customer inquiries.
• Prepare detailed work papers and present findings according to Government Auditing Standards (GAS) and CMS requirements.
• Gain experience with applicable federal laws, regulations, policies, and audit procedures.
• Perform complex cost‑report desk reviews and audits, including acceptance, interim rate reviews, final settlements and tentative settlements.
• Perform cost‑report reopenings and complex calculations related to payment exception requests.
• Assist in supervising work of lower‑level associates when required.
• Participate in special projects, appeals work (position papers, jurisdictional reviews, PRRB hearings, administrative resolutions), and maintain accurate logs and tracking systems.
• Attend team meetings, staff meetings, and training sessions.
Audit & Reimbursement III

– Minimum Requirements
• BA/BS degree with a minimum of 3 years audit/reimbursement or related Medicare experience; equivalent education/experience acceptable.
• Foreign national applicants must meet residency requirement of living in the United States at least three of the past five years.
Audit & Reimbursement III – Preferred Skills & Experience
• Accounting degree preferred.
• Knowledge of CMS program regulations, cost‑report format and computer systems (Word & Excel). приключительной степени?; MBA, CPA or CIA strongly preferred.
• Must obtain required continuing ఏ
• Valid driver’s license and ability to travel (may be required).
Audit & Reimbursement Senior – riscos Responsibilities
• Evaluate work performed by other associates to ensure accurate reimbursement.
• Assist Audit & Reimbursement Leads/Managers in training and development of associates;hnten *
• Participate in special projects and workgroup initiatives.
• Prepare detailed work papers and present findings per GAS and CMS requirements.
• Analyze and interpret data, recommend actions based on judgment.
• Conduct supervisory review of cost‑report desk reviews and audits.
• Review complex exception requests, CMS change requests, and perform supervisory review of complex Medicare Part A reimbursement areas (DSH, Bad Debts, Medical Education, Nursing & Allied Health, Organ Acquisition, Wage Index, etc.).
• Prepare and perform supervisory review of cost‑report acceptance, interim rate reviews, tentative settlements, final settlements and reopening.
• Manage caseload of Medicare cost‑report appeals (position papers, jurisdictional reviews, PRRB hearings, administrative resolutions, PRRB or CMS requests).
• Maintain accurate logs, case files, and tracking systems.
• Assist in mentoring less experienced associates.
Audit & Reimbursement Senior

– Minimum Requirements
• BA/BS degree with a minimum of 5 years audit/reimbursement or related Medicare experience; equivalent education/experience acceptable.
• Foreign national applicants must meet residency requirement of living in the United States at least three of the past five years.
Audit & Reimbursement Senior – Preferred Skills & Experience
• Accounting degree preferred.
• Knowledge of CMS program regulations, cost‑report format and computer systems (Word & Excel) strongly preferred.
• Preferred advanced credentials: MBA, CPA, CIA, or CFE.
• Demonstrated leadership experience preferred.
• Valid driver’s license and ability to travel (may be required).

Important Notice: If this position is assigned to a Government Business Division entity, the applicant and incumbent are/Linux 'sensitive position' and may be subject to additional requirements (background checks, clearances, segregation of duties, etc.).

Elevance Health only accepts resumes for compensation from agencies with a signed agreement. Unsolicited resumes are deemed property of Elevance Health.

Equal Employment Opportunity: Elevance Health is an Equal Employment Opportunity employer; all qualified applicants are considered кухня for employment without regard to age, citizenship status, color, creed, disability, ethnicity, national origin, race, religion, sex, sexual orientation, veteran status or any other protected status under federal, state or local law. Applicants requiring accommodations may contact elevancehealthj

Qualified applicants with arrest or conviction records will be considered in accordance with federal, state and local laws, including (but not limited to) the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.