Audit & Reimbursement Lead- Quality Auditor

National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

The Audit & Reimbursement Lead is a member of the Quality Assurance (QA) Department and is responsible for providing technical direction, workload planning, associate mentoring, operational support on a day-to-day basis and examining and evaluating the accuracy of transactions under regulations and company guidelines.

How you will make an impact:

• Reviews work of the associates to ensure they are following the appropriate guidelines, provides training both in a formal and informal setting, reviews the policies and procedures to make sure they are appropriate, and monitors workload inventory to ensure timely completion.
• Handles complex case research and resolutions.
• Will support the Appeal Unit with appeal issues as assigned.
• Participates in special projects and review of work done by lower level auditors.

• Analyzes and interprets data and makes recommendations for change based on their judgment and experience.
• Able to work independently on assignments and under minimal guidance from the manager.
• Monitors inventory to ensure workflow remains uninterrupted.
• Assists management with workload and financial budget responsibilities.
• Must have extensive knowledge of CMS principles, law and regulations.
• Works with management on interaction with internal and external audits and performance measures.
• Assists in ISO and NASBA certification activities.

Minimum Qualifications:

• Requires a BA/BS degree and a minimum of 8 years audit/reimbursement or related Medicare experience which includes previous experience at a Senior Auditor level in health care, public accounting or a government agency; or any combination of education and experience, which would provide an equivalent background.
• This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Preferred Skills, Capabilities, and Experiences:

• Accounting degree preferred.
• Experience in software used to file and finalize cost reports and experience with paperless audit software applications preferred.
• Demonstrated leadership experience; through knowledge of CMS program regulations and cost report format preferred.
• Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.
• MBA, CPA, CIA or CFE preferred. Must obtain Continuing Education Training requirements (where required).
• A valid driver’s license and the ability to travel to worksite and other locations as necessary.