Audit & Reimbursement II

Anthem, Inc. Nashville , TN 37201

Posted 2 weeks ago

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it's a powerful combination. It's the foundation upon which we're creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

NGS Audit & Reimbursement Auditor II - Appeals

This position can sit remotely with preferred office locations: Syracuse NY, Indianapolis IN, Richmond VA, or S. Portland ME.

This position is part of the Medicare Administrative Contract (MAC) with the Centers for Medicare and Medicaid Services (CMS). This position will support the Medicare part A Audit& Reimbursement department. This includes, but not limited to, processing provider submitted Medicare cost reports. The intent of this position is to support the Medicare cost report appeals workload, however it may include the need to support all functions within the Audit & Reimbursement department. These functions include but not limited to: Cost report acceptance, tentative settlements, rate reviews, desk reviews, audits, final settlements, reopenings, appeals and other compliance/reimbursement review.

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 will receive training, participate in audit related 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.

Primary duties applicable to the Medicare cost report Appeals workload include, but are not limited to:

  • Under guided supervision, participate in completing appeals related work:

  • Position papers

  • Jurisdictional Reviews

  • Maintaining accurate records by updating all logs, case files, tracking systems

  • Participate in all team meetings, staff meetings, and training sessions.

  • Document findings, prepare detailed work papers and present audit adjustment reports in accordance with GAS and CMS requirements

  • Analyze and interpret data per a provider's trial balance, financial statements, financial documents or other related healthcare records

  • 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

Qualifications

Minimum Qualifications:

  • Requires a BA/BS degree, preferably in accounting; 2-5 years of audit/reimbursement or related Medicare experience; thorough knowledge of CMS program regulations and cost report format; knowledge of CMS computer systems and Microsoft Office Word and Excel; or any combination of education and experience, which would provide an equivalent background.

The skills/competencies listed below are preferred but not required:

  • Certified Public Accountant (CPA) or Certified Internal Auditor (CIA) or CPA Eligible

  • Knowledge of Medicare Part A Laws, regulations, program manuals and audit policies

  • Knowledge of CMS computer systems

  • Knowledge of the Medicare cost report

  • Demonstrated understanding of accounting principles, auditing theories, or math concepts obtained through formal education and/or work related experience

  • Must obtain Continuing Education Training requirements.

  • Must possess effective verbal and written communication skills

  • Experience in Microsoft Office Word, Excel and Outlook

  • Effective organization and time management skills

  • Effective problem solving skills

  • Excellent interpersonal skills with the ability to establish working relationships with individuals at varying levels within the organization

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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

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Audit & Reimbursement II

Anthem, Inc.