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Anthem, Inc. Audit & Reimbursement Job Family II or III in Newbury Park, California


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.

NGS Audit & Reimbursement Auditor II or III - Reopening

Work Location – Any NGS Office or Work from Home

This position is part of the Medicare Administrative Contract (MAC) with the Centers for Medicare and Medicaid Services (CMS). This position will support the Medicare part A Audit& Reimbursement department. This includes, but not limited to, processing provider submitted Medicare cost reports. The intent of this position is to support the Medicare cost report reopening workload, however it may include the need to support all functions within the Audit & Reimbursement department. These functions include but not limited to: Cost report acceptance, tentative settlements, rate reviews, desk reviews, audits, final settlements, reopenings, appeals and other compliance/reimbursement review.

Primary Purpose: The Audit and Reimbursement Auditor II or III, under guided supervision, will support audit activities of healthcare providers’ financial and statistical records in accordance with Government Auditing Standards (GAS). The auditor will receive training, participate in audit related workload, and have opportunities to participate on special projects. This position provides a valuable opportunity to gain exposure in the healthcare reimbursement and financial industry.

Primary duties applicable to the Medicare cost report Reopening workload include, but are not limited to:

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

  • Perform level 1 or level 2 audit review as part of the reopening process on all areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition and all cost based principles

  • Document findings, prepare detailed work papers and present audit adjustment reports in accordance with GAS and CMS requirements

  • Analyze and interpret data per a provider’s trial balance, financial statements, financial documents or other related healthcare records

  • Must be able to perform all duties of lower level positions as directed by management

  • Gain experience with applicable Federal Laws, regulations, policies and audit procedures

  • Actively participate in development of Audit & Reimbursement standard operating procedures

  • Activity participate in workgroup initiatives to enhance quality, efficiency and training

  • Participate on special projects as needed


NGS Audit & Reimbursement II –


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.

Audit & Reimbursement III


The requirements listed below are representative of the knowledge, skill and/or ability required:

  • Recommended BA/BS degree (preferably in Accounting, Finance, Business Administration, or Healthcare Management), or 3-5 years of audit/reimbursement experience or related Medicare cost report experience; or any combination of education and experience.

  • Demonstrated understanding of accounting principles, auditing theories, or math concepts obtained through formal education and/or work related experience

  • Knowledge of the Medicare cost report

  • Knowledge of Medicare Part A Laws, regulations, program manuals and audit policies

  • Must obtain Continuing Education Training requirements.

  • Must possess effective verbal and written communication skills

  • Experience in Microsoft Office Word, Excel and Outlook