Vacancy expired!
Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 Lead Auditor - AppealsWork Location – Any NGS Office or Work from HomeThis 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
reopening workload include, but are not limited to:
Assign, monitor, and track Appeals workload with other
Appeal Lead Auditors
Perform supervisory reviews on all appeals work – position
papers, jurisdiction reviews, workpapers, Administrative Resolutions, and other
work.
Review Medicare cost report re-openings initiated from
provider requests, CMS requests, or by the MAC
Perform level 2 audit review as part of the appeal 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
Coordinate crossover work with the Reopening team
Assist management on monitoring and training lower level
staff.
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 on special projects as needed
Qualifications Requirements:The requirements listed below are representative of the
knowledge, skill and/or ability required:
Requires a BA/BS degree, preferably in accounting; 10+
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
Anthem, Inc. is ranked
as one of America’s Most Admired Companies among health insurers by Fortune
magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To
learn more about our company and apply, please visit us at
careers.antheminc.com. An Equal Opportunity
Employer/Disability/Veteran.REQNUMBER: PS36577
Vacancy expired!