Part A/HHH Appeals Specialist

CGS Administrators, LLC•Nashville, TN

2d•Onsite

About The Position

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. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Logistics: Logistics: CGS –one of BlueCross BlueShield's South Carolina subsidiary companies. Position is onsite at Century Blvd, Ste ST610, Nashville, TN 37214-3685 Work hours: Eight-hour shift starting between 6:00 am and 9:00 am Monday through Friday allowing you to work the schedule that best fits your needs after training.

Requirements

High School Diploma or equivalent
Two years job related field (insurance claims, medical office, or similar).
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

Excellent computer skills with the ability to navigate between multiple software platforms and work on multiple computer screens.
Intermediate Excel skills.
Medical claims processing, appeals, billing, or coding experience.

Responsibilities

Perform non-medical reviews and process redetermination letters ensuring timeliness and accuracy.
Prepare unit reports, analyze and interpret workload, and process issues utilizing various software tools.
Update letters and documents within the department when necessary.
May gather and prepare documentation for legal inquiries and administrative requests.