Anthem, Inc. Audit & Reimbursement Lead in Indianapolis, Indiana
SHIFT: Day Job
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 Lead 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 is 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:
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
Actively participate in workgroup initiatives to enhance quality, efficiency and training
Participate on special projects as needed
NGS Audit & Reimbursement Lead
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. 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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