Louisville, Kentucky

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 Senior Auditor - Appeals

Work Location – Any NGS Office or Work from Home

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

  • Manage caseload of Medicare cost report Appeals
    • Position papers
    • Jurisdictional Reviews
    • PRRB Hearings
    • Administrative Resolutions
    • PRRB or CMS requests
    • Monitor all communications related to caseload
    • Maintaining accurate records by updating all logs, case files, tracking systems
  • Perform level 1 or level 2 audit review as part of the appeal process (may also include reopening process) on all areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition and all cost based principles
  • Document findings, prepare detailed work papers and present audit adjustment reports in accordance with GAS and CMS requirements
  • Analyze and interpret data with recommendations based on judgment and experience
  • Must be able to perform all duties of lower level positions as directed by management
  • Actively participate in development of Audit & Reimbursement standard operating procedures
  • Activity participate in workgroup initiatives to enhance quality, efficiency and training
  • Participate in all team meetings, staff meetings, and training sessions.
  • Participate on special projects as needed

Qualifications

This position supports Anthem’s federal contracting business, which is subject to the Covid-19 vaccination requirements set forth in Executive Order 14042 and its implementing guidance. Individuals performing work in this position must be able to prove they are fully vaccinated by providing required documentation. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis.  Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com.

The requirements listed below are representative of the knowledge, skill and/or ability required:

  • Requires a BA/BS degree, preferably in accounting; 8+ years of audit/reimbursement or related Medicare experience; thorough knowledge of CMS program regulations and cost report format;
  • Knowledge of CMS computer systems
  • Knowledge of the Medicare cost report
  • Knowledge of Medicare Part A Laws, regulations, program manuals and audit policies
  • Must obtain Continuing Education Training requirements. MBA, CPA, CIA or CFE preferred. Demonstrated leadership experience preferred.
  • 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
  • Ability to travel may be required   

Applicable to Colorado Applicants Only

Annual Salary Range*: $70,960-$88,700

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 

* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  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.

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.

Louisville, Kentucky

If you are active-duty military, reserve, or a military veteran, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time. 

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military 

WE ARE HIRING

Anthem, Inc. is currently seeking military veterans and military spouses for a variety of open roles.  Our immediate needs include Support Technical Engineer, Lead Engineer, Developer, Systems Analyst, Network Data Specialist, and Provider Network Manager roles.  Whether you are looking to transition into an IT career or if you have experience under your belt in the Technology field, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.

If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!

Not sure where to start?  Send RecruitMilitary Success Manager, Taylor Groves, your questions at taylor.groves@recruitmilitary.com 

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