Audit & Reimbursement II or III (NGS) - 123026
Location:
South Portland , Maine
Posted:
November 10, 2016
Reference:
1689522856
Your Talent. Our Vision. AtNational 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 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.

TheAudit & Reimbursement II (NGS)position is responsible for completing 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.

Must be able to perform all duties of lower level positions as directed by management.

TheNGS Audit & Reimbursement IIIposition is responsible for completing limited and full desk reviews on teaching, organ acquisition hospitals and other complex provider cost reports. Primary duties may include, but are not limited to:

Plans, directs and controls specific provider audits.

In charge auditor on large and/or complex field audits.

Responsible for assigning, reviewing, and approving the work performed by auditors on team audits.

Responsible for completing interim rate reviews final settlements and tentative settlements as assigned.

Will support the Appeal Unit with appeal issues as assigned.

Participates in special projects and review of work done by lower level auditors as assigned.

Performs complex calculations related to payment exception requests and reviews exception request workpapers prepared by others.

Analyzes and interprets data and makes recommendations for change based on judgment and experience.

May perform Part A provider enrollment responsibilities as needed.

Must be able to perform all duties of lower level positions as directed by management.

/(The level of hire will be determined by the hiring manager.)/

Requires a BA/BS degree, preferrably in accounting; 2-7 years of audit/reimbursement or related Medicare experience; thorough knowledge of CMS program regulations and cost report format; excellent 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).

Must have a valid driver's license and the ability to travel is 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./

/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /

Job Accounting/Finance/Auditing

Title: Audit & Reimbursement II or III (NGS) - 123026

Location: VA-Richmond

Other Locations: ME-South Portland, United States, NY-Syracuse, IN-Indianapolis

Requisition ID: 123026

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