Audit & Reimbursement II

Description

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Audit & Reimbursment II

This is a remote position open nationwide

The Audit & Reimbursment II is responsible for completing all activities of an audit in addition to limited and full desk reviews on providers as assigned.

Primary duties may include, but are not limited to:

• 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.

Qualifications

Minimum Requirements:

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

Preferred Qualifications:

• 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.
• Must obtain Continuing Education Training requirements (where required).
• 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 Government Business Division in which they are employed.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem 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 ability@icareerhelp.com for assistance.