Audit & Reimbursement II

Audit and Reimbursement II

Virtual:  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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

• Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations.

The Audit & Reimbursement II 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.
• Responsible for completing interim rate reviews, tentative settlements and final settlements of providers 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

Minimum Requirements:

• 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.

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.

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."

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $56,960-$89,712

Locations: Maryland; Massachusetts; 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, paid time off, stock, 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.