What are the responsibilities and job description for the Audit/Appeals Analyst I position at Blue Cross and Blue Shield of Alabama?
Overview
Department Overview
The Audit Department at our subsidiary has associates working remotely in several states with physical offices located in Birmingham, AL. This unit is responsible for work related to audits and appeals for a subset of institutional providers located across the country. The audit sector conducts Medicare audits on provider cost reports to determine payment and calculates the final settlement determination on the audited cost reports. The audit area also handles cost report appeals and reopenings from various other Medicare contractors, as assigned by the Medicare Administrative Contractors (MACs).
Primary Responsibilities
The incumbent will assist with all work related to audits, appeals, and special projects under direct supervision. All work must be completed within budget allocations, as well as in a manner that meets or exceeds quality expectations and contracting requirements.
The work related to audits and appeals must be performed in accordance with Generally Accepted Accounting Principles (GAAP), Generally Accepted Auditing Standards (GAGAS), governing regulations, issued instructions, internal policy and procedure manuals, board policies, rules, procedures, timeframes, and instructions. Duties can include any one or more of the following tasks: requesting documentation; completing regulatory research; performing audit work; incorporating adjustments; making recommendations for final settlement; as well as drafting preliminary/final position papers; initiating discovery requests; handling reopening requests; completing jurisdictional challenges; and executing administrative resolutions.
The incumbent must continuously handle all information, documents, data, and interactions in a secure and confidential manner. Further, the incumbent must perform at all times in a professional manner as a representative of Cahaba Safeguard Administrators (CSA), the government, and other entities.
Over time, the incumbent is expected to develop and apply an appropriate level of knowledge, skills, and understanding of work at the Audit/Appeals Analyst I level in order to meet developmental goals and to be considered for potential promotion.
This position can be filled at a higher level based upon experience.
Summary Of Qualifications
The work schedule for this position will be full-time remote. Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A remote work schedule is subject to amendment or termination at any time by the Company.
Terms and Agreements
By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Department Overview
The Audit Department at our subsidiary has associates working remotely in several states with physical offices located in Birmingham, AL. This unit is responsible for work related to audits and appeals for a subset of institutional providers located across the country. The audit sector conducts Medicare audits on provider cost reports to determine payment and calculates the final settlement determination on the audited cost reports. The audit area also handles cost report appeals and reopenings from various other Medicare contractors, as assigned by the Medicare Administrative Contractors (MACs).
Primary Responsibilities
The incumbent will assist with all work related to audits, appeals, and special projects under direct supervision. All work must be completed within budget allocations, as well as in a manner that meets or exceeds quality expectations and contracting requirements.
The work related to audits and appeals must be performed in accordance with Generally Accepted Accounting Principles (GAAP), Generally Accepted Auditing Standards (GAGAS), governing regulations, issued instructions, internal policy and procedure manuals, board policies, rules, procedures, timeframes, and instructions. Duties can include any one or more of the following tasks: requesting documentation; completing regulatory research; performing audit work; incorporating adjustments; making recommendations for final settlement; as well as drafting preliminary/final position papers; initiating discovery requests; handling reopening requests; completing jurisdictional challenges; and executing administrative resolutions.
The incumbent must continuously handle all information, documents, data, and interactions in a secure and confidential manner. Further, the incumbent must perform at all times in a professional manner as a representative of Cahaba Safeguard Administrators (CSA), the government, and other entities.
Over time, the incumbent is expected to develop and apply an appropriate level of knowledge, skills, and understanding of work at the Audit/Appeals Analyst I level in order to meet developmental goals and to be considered for potential promotion.
This position can be filled at a higher level based upon experience.
Summary Of Qualifications
- Bachelor’s degree in Accounting, Finance, Business Administration, or other job-related field of study
- Demonstrated computer proficiency including Microsoft Office products, including Excel and Word
- Problem solving, organizational, and time management skills that allow for the prioritization of work to meet timeframes, deadlines, and budget/resource requirements
- Experience communicating clearly and effectively in oral and written form
- Strong interpersonal skills and experience maintaining professionalism in all situations
- Experience taking direction to ensure quality and accuracy of work performed, as well as accepting feedback to improve performance and develop skills
- Experience working independently and contributing as part of a team to complete assigned work
- Prior work experience in the areas of healthcare/audit/appeals; or in lieu of specific work experience, possess a basic understanding of the healthcare/audit/appeals environment that would form the basis for developing required audit knowledge, skills, and aptitude is preferred
- Experience comprehending Medicare reimbursement principles is preferred
- Certified Public Accountant (CPA) is preferred
- Juris Doctorate (JD) is preferred
- This position can be filled at a higher level based upon experience.
The work schedule for this position will be full-time remote. Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A remote work schedule is subject to amendment or termination at any time by the Company.
Terms and Agreements
By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.