Appeals Specialist - (CGS Admin)

BlueCross BlueShield of South Carolina•Nashville, TN

3d•Hybrid

About The Position

This position is within CGS Administrators, a subsidiary company of BlueCross BlueShield of South Carolina. CGS has been 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 for more than 50 years. The Appeals Specialist performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy. They prepare unit reports, analyze and interpret workload, and process issues utilizing various software tools. This role may also involve gathering and preparing documentation for legal inquiries and administrative requests.

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.