Appeals Specialist - (CGS Admin)

CGS Administrators, LLC•Nashville, TN

4d•Hybrid

About The Position

This position is within CGS Administrators, a subsidiary of BlueCross BlueShield of South Carolina. CGS has been a provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for over 50 years. The company is a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers. CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care providers, and medical equipment suppliers in 33 states, supporting the needs of more than 20 million Medicare beneficiaries nationwide. The company delivers outstanding service to its customers.

Requirements

High School Diploma or equivalent
2 years job related field.
Demonstrated proficiency in word processing and spreadsheet software.
Excellent organizational, customer service, and written and verbal communication skills.
Good judgment skills.
Proficiency in spelling, punctuation, and grammar skills.
Microsoft Office.

Nice To Haves

Experience in medical claims processing, appeals, or coding strongly preferred
Medicare Part B experience preferred
Strong computer proficiency, with the ability to navigate multiple systems and work across dual screens efficiently
Intermediate-level Excel skills
Experience creating letters and documents by reviewing appeals and extracting information with a high degree of accuracy; updates departmental documents as needed.

Responsibilities

Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
Updates letter's and documents within the department when necessary.
May gather and prepare documentation for legal inquiries and administrative requests.