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Audit & Reimbursement II

Company: Anthem, Inc
Location: Placentia
Posted on: December 22, 2019

Job Description:

Audit & Reimbursement II (PS23653)Location: United StatesNewRequisition #: PS23653Post Date: 6 days agoYour Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, its a powerful combination. Its the foundation upon which were 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 IIAudit & Reimbursement II 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. - Preferred experience/duties include - Cost of care report Appeals experience preferred.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). - Must have a valid driver's license and the ability to travel occasionallyis required.Anthem, Inc. is ranked as one of Americas 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 antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran

Keywords: Anthem, Inc, Placentia , Audit & Reimbursement II, Accounting, Auditing , Placentia, California

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