Summary
Provides all redetermination case file information within the specified time requirement while maintaining accuracy and departmental standards. Suspends claims in applicable claim system and tracks all data.
Description
Logistics
CGS one of BlueCross BlueShield's South Carolina subsidiary companies.
This is a full-time position (40 hours/week), Monday–Friday, 8:00 AM–4:30 PM CST. The role is hybrid after training (approximately six weeks), with onsite work required at 26 Century Boulevard, Suite NT600, Nashville, TN 37214-3685.
This role supports the QIC (Qualified Independent Contractor) workload tied to DME Medicare appeals.
When a supplier submits a redetermination on a previously processed claim and disputes the outcome, the case advances to reconsideration conducted by the QIC.
You will compile and provide the documentation packets the QIC requests.
Centers for Medicare & Medicaid Services (CMS) Requirements: This position supports a federal government contract and is subject to CMS residency requirements. Candidates must have resided in the United States for at least three (3) of the last five (5) years. This is a business requirement tied to our government contracts. Residency will be verified during the background check process; candidates who do not meet this requirement will not be able to proceed.
What You’ll Do:
Perform the administrative function of validating and processing reconsideration requests within designated timeliness and quality standards. Identify, retrieve, and prepare documentation for batching; build case files in the established format; annotate claims in the appropriate claim and internal systems for proper tracking and reporting; copy, fax, and log data.
Maintains databases and updates the system for tracking purposes to ensure timeliness and quality standards are met.
To Qualify for This Position, You’ll Need:
Required Education: High School Diploma or equivalent
Required Work Experience: 1 year administrative support, clerical, or claims experience.
Required Skills and Abilities: Good organizational, decision making, customer service skills. Detail oriented. Analytical or critical thinking skills.
Required Software and Tools: Microsoft Office.
What We Prefer You Have:
Preferred Work Experience: 2 years-clerical, research, or related office experience.
Preferred Skills and Abilities: Ability to handle confidential or sensitive information with discretion.
Work Environment: Typical office environment. Fast-paced, deadline driven environment.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
Clerical & Data Entry (1)