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Audit & Reimbursement

Company: Anthem
Location: Modesto
Posted on: November 10, 2019

Job Description:

Audit & Reimbursement II-PS29366Location: United StatesRequisition #: PS29366Post Date: Oct 29, 2019Your Talent. OurVision. At National Government Services (NGS), an independent subsidiary ofAnthem, Inc. and one of the largest Medicare contractors in the country, its apowerful combination. Its the foundation upon which were creating greateraccess to care for our members, greater value for our customers and greaterhealth for our communities.Join us andtogether we will drive the future of health care.This is an exceptionalopportunity to do innovative work that means more to you and those we serve.Audit& Reimbursement II Open to any NGS office or work from home.Responsiblefor completing Audit & Reimbursement work including limited and full deskreviews on providers as assigned. Primary duties may include, but are notlimited to:

  • Performsaudit work scoped by the desk reviews and will be the in-charge auditor onsmall and less complex audits.
  • Assistshigher level auditor on field work and appeals as assigned.
  • Responsiblefor completing interim rate reviews, tentative settlements and finalsettlements of providers as assigned.
  • Performsspecial audits of End Stage Renal Disease (ESRD) providers and providerexception requests as assigned.
  • UpdatesSTAR, FISS and PSF as assigned.
  • Participatesas a team member on audits of provider's records and other projects.
  • Analyzesand interprets data and makes recommendations for change based on theirjudgment and experience.
  • Mustbe able to perform all duties of lower level positions as directed bymanagement.Requires aBA/BS degree, preferably in accounting; 2-5 years of audit/reimbursement orrelated Medicare experience; thorough knowledge of CMS program regulations andcost report format; knowledge of CMS computer systems, Microsoft Office Wordand Excel; or any combination of education and experience, which would provide anequivalent background.
    • MBA, CPA or CIApreferred.
    • Mustobtain Continuing Education Training requirements (where required).
    • Must havea valid driver's license and the ability to travel is required.Anthem, ranked as one of Americas Most Admired Companies among health insurers byFortune magazine and is a 2017 DiversityInc magazine Top 50 Company forDiversity. To learn more about our company and apply, please visit us Equal Opportunity Employer/Disability/Veteran

Keywords: Anthem, Modesto , Audit & Reimbursement, Accounting, Auditing , Modesto, California

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