Anthem Inc. Virginia Jobs

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Anthem, Inc. Audit & Reimbursement III in Richmond, Virginia


SHIFT: Day Job

SCHEDULE: Full-time

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.

The Audit and Reimbursement III position is responsible for completing limited and full desk reviews on teaching, organ acquisition hospitals and other complex provider cost reports.

Primary duties may include, but are not limited to:

  • Review Medicare cost report re-openings initiated from provider requests, CMS requests, or by the MAC.

  • Plans, directs and controls specific provider audits. In charge auditor on large and/or complex field audits.

  • Responsible for assigning, reviewing, and approving the work performed by auditors on team audits.

  • Responsible for completing interim rate reviews final settlements and tentative settlements as assigned.

  • Under guided supervision, participate in completing appeals related work:

  • Position papers and jurisdictional reviews

  • Participates in special projects and review of work done by lower level auditors as assigned.

  • Performs complex calculations related to payment exception requests and reviews exception request workpapers prepared by others.

  • Analyzes and interprets data and makes recommendations for change based on 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.


Minimum Qualifications:

  • Requires a BA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

  • Thorough knowledge of CMS program regulations and cost report formatl; excellent knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.

  • 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.

If this job is assigned to any Government Business Division entity, the applicant and incumbent 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.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact for assistance.

REQNUMBER: PS65599-Richmond-Richmond