Part A/HHH Appeals Specialist

BlueCross BlueShield of South Carolina•Nashville, TN

9d•Onsite

About The Position

We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. 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. Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future. This position requires CMS Security Clearance as it falls within a division subject to Centers for Medicare and Medicaid Services residency requirements. Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. This position is full-time (40 hours/week) Monday-Friday located onsite at One Century Plaza, Nashville, TN. This position is not eligible for sponsorship now or in the future.

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.

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 letters and documents within the department when necessary.
May gather and prepare documentation for legal inquiries and administrative requests.