Audit & Reimbursement II
Elevance Health

Job Info

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Audit & Reimbursement II

Primary Purpose: The Audit and Reimbursement Auditor II, under guided supervision, will support audit activities of healthcare providers' financial and statistical records in accordance with Government Auditing Standards (GAS). The Auditor II will gain experience on Medicare Part A Audit and Reimbursement as part of our Medicare Administrative Contract (MAC) with the Federal Government (The Centers for Medicare and Medicaid Services (CMS) branch of the Department of Health and Human Services). The auditor will receive training, participate in our Audit and Reimbursement workload, and have opportunities to participate on special projects. This position provides a valuable opportunity to gain exposure in the healthcare reimbursement and financial industry.

Entry level position responsible for basic Audit & Reimbursement functions

Primary duties may include, but are not limited to:

• Analyzes and interprets data and makes recommendations for change based on their judgment and experience.

• Interacts with the provider community and provider consultants regarding payments to providers, etc.
• Document findings, prepare detailed work papers and present audit adjustment reports in accordance with GAS and CMS requirements
• Gain experience with applicable Federal Laws, regulations, policies and audit procedures
• Respond timely and accurately to customer inquiries
• Ability to multi- task while independently and effectively prioritizing work using time management, initiative, project management and problem-solving skills
• Responsible for completing limited and full desk reviews on providers as assigned
• 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 audit work and appeals as assigned
• Perform supervisory review on less complex Medicare cost reports
• Analyze and interpret data per a provider's trial balance, financial statements, financial documents or other related healthcare records

Minimum Qualifications:

• Requires a BA/BS degree or a minimum of 2 years of Medicare audit/reimbursement or related Medicare experience; or any combination of education and experience, which would provide an equivalent background.
• Knowledge of Microsoft Word and Excel

Preferred Qualifications:

• Degree in Accounting or other Business related degree
• A valid driver's license and the ability to travel may be required

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