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Audit & Reimbursement II*Future Opportunity* Indianapolis, IN

0140080 Requisition #
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.
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 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.

  • 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 is required.
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 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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Apply your problem-solving skills and work on enterprise-level projects with cross-functional teams.

Operations professionals at Anthem:

  • Drive greater consistency, standardization and constant improvement of our business processes and technology platforms
  • Contribute to our goal of reducing health disparities between different segments of the population by working to optimize processes that increase health care affordability and transparency
  • Leverage advanced technology to continually offer associates and members new ways to connect and share information related to their health and health benefits

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