Audit & Reimbursement III

Title: Audit & Reimbursement III (US)

Location:

IN-INDIANAPOLIS, 220 VIRGINIA AVE

TX-DENISON, 4616 HIGHWAY 75, STE 240

MD-BALTIMORE, 2245 ROLLING RUN DR, STE 9

WI-Waukesha, N17W24222 Riverwood Dr., Ste 300

OH-CINCINNATI, 3075 VANDERCAR WAY

VA-RICHMOND, 2103 STAPLES MILL RD,

KY-LOUISVILLE, 13550 TRITON PARK BLVD

NH-MANCHESTER, 1155 ELM ST, STE 100 & 200

TX-GRAND PRAIRIE, 2505 N HWY 360, STE 300

NY-EAST SYRACUSE, 5000 BRITTONFIELD PKWY, STE 100

MN-GILBERT, 730 S BROADWAY

LA-METAIRIE, 3850 N CAUSEWAY BLVD, STE 1770

NC-DURHAM, 1960 IVY CREEK BLVD,

GA-COLUMBUS, 6087 TECHNOLOGY PKWY

NV-LAS VEGAS, 3634 S MARYLAND PKWY

TX-HOUSTON, 5959 CORPORATE DR, STE 1300

VA-NORFOLK, 5800 NORTHAMPTON BLVD

MO-ST LOUIS, 1831 CHESTNUT ST

WV-CHARLESTON, 200 ASSOCIATION DR, STE 200

FL-MIAMI, 11430 NW 20TH ST, STE 300

DE-WILMINGTON, 123 S JUSTISON ST, STE 200

OH-MASON, 4241 IRWIN SIMPSON RD

OH-SEVEN HILLS, 6000 LOMBARDO CENTER, STE 200

RI-SMITHFIELD, 37 THURBER BLVD, STE 108

MA-HINGHAM, 75 SGT WILLIAM B TERRY DR, STE 1004

NV-LAS VEGAS, 9133 W RUSSELL RD

PA-HARRISBURG, 2400 THEA DR, STE 3B

ME-SOUTH PORTLAND, 2 GANNETT DR

NC-WINSTON-SALEM, 5650 UNIVERSITY PKWY

GA-ATLANTA, 740 W PEACHTREE ST NW

OH-COLUMBUS, 8940 LYRA DR, STE 300

FL-TAMPA, 5411 SKY CENTER DR

VA-Norfolk, 240 Corporate Blvd, Suite 100

IA-W DES MOINES, 4800 WESTOWN PKWY, STE200

VA-ROANOKE, 602 S JEFFERSON ST

Job Description:

Anticipated End Date:

2025-07-11

Position Title:

Audit & Reimbursement III (US)

Job Description:

Audit & Reimbursement III

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 & Reimbursement III is responsible for completing limited and full desk reviews on teaching, organ acquisition hospitals and other complex provider cost reports.

How you will make an impact:

• Plans, directs and controls specific provider audits.
• In charge auditor on large and/or complex field audits.
• Responsible for assigning, reviewing, and approving the work performed by auditors on team audits.
• Responsible for completing interim rate reviews final settlements and tentative settlements as assigned.
• Will support the Appeal Unit with appeal issues as assigned.
• Participates in special projects and review of work done by lower level auditors as assigned.
• Performs complex calculations related to payment exception requests and reviews exception request workpapers prepared by others.
• Analyzes and interprets data and makes recommendations for change based on judgment and experience.
• May perform Part A provider enrollment responsibilities as needed.
• Associates in this role are expected to maintain continuing education requirements.

Minimum Requirements:

• Requires a BA/BS degree and a minimum of 5 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:

• 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.
• A valid driver's license and the ability to travel to worksite and other locations as necessary.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $61,560 to $102,060

Locations: Maryland, Minnesota, Nevada, and New York

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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 Government Business Division in which they are employed.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

AFA > Audit, Comp & Risk

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.