Audit & Reimbursement II - PS36686
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Wilmington, DE 19893
DescriptionSHIFT: 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
Audit & Reimbursement II – (PS36686)
Responsible for completing audits and claims
accuracy reviews on paid claims.
Primary duties may include, but are not limited
+ Performs audit
work scoped by the lead of the department.
+ Audits finalized
claims payments and looks for errors in payment by comparing to Provider
contracts, Health Plan policies, CCI edits, CMS payment rules &
+ Responsible for
completing interim rate reviews, tentative settlements and final settlements of
providers as assigned.
+ Performs special
audits such as End Stage Renal Disease (ESRD) providers and provider exception
requests 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
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). A valid
driver’s license and the ability to travel may be required.
**Preferred valid coding certification