Job Details

ID #4325855
State Wisconsin
City Fonddulac
Full-time
Salary USD TBD TBD
Source Anthem, Inc.
Showed 2020-07-09
Date 2020-07-10
Deadline 2020-09-08
Category Et cetera
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Audit & Reimbursement II - PS36686

Wisconsin, Fonddulac 00000 Fonddulac USA

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. Audit & Reimbursement II - (PS36686)Responsible for completing audits and claims

accuracy reviews on paid claims. Primary duties may include, but are not limited

to:

Performs audit

work scoped by the lead of the department.

Audits finalized

claims payments and looks for errors in payment by comparing to Provider

contracts, Health Plan policies, CCI edits, CMS payment rules &

regulations.

Responsible for

completing interim rate reviews, tentative settlements and final settlements of

providers as assigned.

Performs special

audits such as End Stage Renal Disease (ESRD) providers and provider exception

requests 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.

Qualifications Requirements: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. 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.Preferred valid coding certificationREQNUMBER: PS36686

Vacancy expired!

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