Provider Appeals Manager
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Job Location:
Columbia, IN - USA
Monthly Salary:
Not Disclosed
Posted on:
10 hours ago
Vacancies:
1 Vacancy
Job Summary
Summary
Manages the successful operations of a department that is responsible for administering part of a Medicare service contract. Oversees all appeals and rebuttals activities and requirements outlined in the National Provider Enrollment (NPE) Statement of Work and applicable sections of the Program Integrity Manual (PIM) ensuring adherence to administrative law principles and CMS regulatory requirements. Acts as a subject matter expert on appeal processes and decisions. Works closely with the Division of Provider Enrollment Appeals at CMS as well as the NPE Program Manager.
Description
Logistics: Palmetto GBA one of BlueCross BlueShields South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 17 Technology Circle Columbia SC 29203.
Government Clearance: This position requires the ability to obtain a security clearance which requires applicants to be a U.S. Citizen.
What Youll Do:
- Provides management oversight of departmental staff and programs ensuring operational consistency and regulatory alignment.
- Ensures compliance with CMS regulations guidelines and performance standards as well as maintaining internal controls and mitigating compliance risk related to appeals.
- Provides general research and analysis on legal matters impacting appeal and rebuttal decisions made by the unit.
- Responsible for drafting standard legal verbiage to be used in correspondence.
- Partners with Legal Compliance and Operations to resolve multifunctional issues and ensure consistent application of CMS and administrative law requirements.
- Participates in special projects including policy development compliance reporting and regulatory change implementation.
To Qualify for This Position Youll Need the Following:
- Required Education: Juris Doctorate or Master of Laws (LLM) degree from a law school accredited by the American Bar Association.
- Required Work Experience: 3 or more years of prior work experience in administrative law three or more years of post-juris doctor (J.D.) and/or post-Master of Laws (LLM) experience in legal writing and research and five or more years of prior supervisory/team lead experience in legal writing legal research and/or administrative law experience can be concurrent.
- Required Skills and Abilities: Excellent verbal and written communication skills. Excellent judgment organizational customer service analytical/critical thinking skills. Proficiency in grammar spelling and punctuation skills. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion. Working knowledge of word processing spreadsheet software.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
- Subsidized health plans dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies theaters zoos theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next:
After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
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 disabilitiesand 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 or call 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. Heres moreinformation.
Some states have required notifications. Heres more information.
Required Experience:
Manager
Key Skills
- Restaurant Experience
- Customer Service
- Employee Evaluation
- Management Experience
- Math
- Employment & Labor Law
- Sanitation
- Leadership Experience
- P&L Management
- Mentoring
- Supervising Experience
- Restaurant Management
