Medicare Appeals Specialist - GHP - Secondary Payer

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POST DATE 9/19/2016
END DATE 10/14/2016

CGI San Antonio, TX

Company
CGI
Job Classification
Full Time
Company Ref #
25b009d8
AJE Ref #
576217312
Location
San Antonio, TX
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
Education
High School Diploma or GED

JOB DESCRIPTION

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Job Description:

Medicare Appeals Specialist - GHP - Secondary Payer Position Description CGI Federal, a wholly owned subsidiary of CGI and an industry leader in providing overpayment recovery services to healthcare payers throughout the US, is conducting a recruitment campaign in San Antonio, TX. Our objective is to hire Medicare Secondary Payer Case Workers who will be responsible for managing health insurance cases for appeal and recovery from employers responsible for an outstanding debt to Medicare. Additionally, there is significant interaction with insurance companies that are identified as being a primary payer to Medicare. To that end, Medicare Secondary Payer (MSP) Case Workers will be responsible for the following: Your future duties and responsibilities Independently manage a work queue consisting of correspondence from employers, Group Health, and Non-Group Health Plans appealing Medicare's assertion of improper coordination of benefits. Use critical reading skills to determine the nature of appeals and correspondence from employers, Group Health Plans and Non-Group Health Plans, ensure adherence to Standard Operating Procedures (SOPs) to determine the next step. Track correspondence through the demand process to ensure a timely response within service level agreements. Evaluate medical claims documentation and coverage policy documentation to determine validity of the appeal. Facilitate and document communication with insurers, and employer groups. Effectively and clearly document communication across multiple systems Answer incoming queries via the telephone, email, and hard copy. Accurately apply payments, and adjustment to accounts receivable. Escalate queries that are not routine or have special circumstances to supervisors in alignment with prescribed processes Maintain confidentiality of all PHI (Oral, written or maintained electronically) ,and adhere to HIPAA guidelines. Required qualifications to be successful in this role To be considered for these roles, applicants must have demonstrated successful performance involving the following traits: High School Diploma or equivalent is required, Bachelor's degree preferred Two+ years of experience working with Claims processing, appeals department preferred Must have knowledge of and understand Medicare, medical terms and processes, how to read and decipher an EOB, MSP a plus Strong analytical and critical thinking skills required Ability to work in a fast paced environment and handle change required Ability to operate a computer and work with PC based software programs is required, basic skills with Microsoft Office Suite of tools including MS Word, MS PowerPoint, MS Excel are required, advanced skills for some positions is desired Ability to multitask in a deadline-driven work environment Attention to detail while maintaining focus on overall mission Organization/time management Ability to learn new methods quickly and eagerness to learn Willingness to work as an individual performer and team player as well as discern and share useful information to achieve common goals Strong verbal and written communication skills are required, including telephone contact, face-to-face, status notes, and business letter writing At CGI, we're a team of builders. We call our employees members because all who join CGI are building their own company - one that has grown to 65,000 professionals located in 40 countries. Founded in 1976, CGI is a leading IT and business process services firm committed to helping clients succeed. We have the global resources, expertise, stability and dedicated professionals needed to achieve results for our clients - and for our members. Come grow with us. Learn more at www.cgi.com.This is a great opportunity to join a winning team. CGI offers a competitive compensation package with opportunities for growth and professional development. Benefits for full-time, permanent members start on the first day of employment and include a paid time-off program and profit participation and stock purchase plans.We wish to thank all applicants for their interest and effort in applying for this position, however, only candidates selected for interviews will be contacted. No unsolicited agency referrals please.All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary depending upon specific assignment, or upon any US government security clearance if required. Qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, gender Identity, sexual orientation, national origin, age, disability, veteran status, pregnancy, or other status protected by law. CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI's legal duty to furnish information. Skills Business AcumenCommunication (Oral/Written)Detail-orientedMulti-tasking Reference 488982

Company Description:

At CGI, we are a team of builders. We call our employees members because all who join CGI are building their own company - one that has grown to 68,000 professionals located in 40 countries. Founded in 1976, CGI is a leading IT and business process services firm committed to helping clients succeed. We have the global resources, expertise, stability and dedicated professionals needed to achieve results for our clients - and for our members. Come grow with us. Learn more at www.cgi.com.

This is a great opportunity to join a winning team. CGI offers a competitive compensation package with opportunities for growth and professional development. Benefits for full-time, permanent members start on the first day of employment and include a paid time-off program and profit participation and stock purchase plans.

We wish to thank all applicants for their interest and effort in applying for this position, however, only candidates selected for interviews will be contacted.

No unsolicited agency referrals please.

Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, protected veteran status or disability.