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Audit & Reimbursement II-NGS-PS7830 in Portland, ME at Anthem, Inc.

Date Posted: 6/8/2018

Job Snapshot

Job Description

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. 
We have an opening for an Audit & Reimbursement II, which may work from our South Portland, ME or Syracuse, NY offices.  The Audit & Reimbursement II will be 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.
  • 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.
  • Must be able to perform all duties of lower level positions as directed by management.
  • Requires a BA/BS degree, preferably in accounting or 2-5 years of audit/reimbursement or related Medicare experience; 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).
  • Must have a valid driver's license and the ability to travel is required.
 The applicant and incumbent for this position 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 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.


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