Medical Reviewer II (Prior-Auth A/B MAC) - CGS

About the role

This open position is within 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. Selected candidates will be reviewing medical records to determine medical necessity, eligibility under Medicare guidelines and identify fraud and abuse of the Medicare system. This role will need strong clinical and computer skills. It will be best for someone who is self-motivated and has excellent time management skills. Excellent for those individuals looking to transition their career from the physical and time demands of direct patient care. The role provides the opportunity for a good home/work life balance with a Monday through Friday daytime schedule, some flexibility, and no regular weekends or holidays. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Logistics: CGS (cgsadmin.com) - one of BlueCross BlueShield of South Carolina's subsidiary companies. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. Sponsorship : This position is not eligible for sponsorship now or in the future. Location: Candidates who live within 40 miles of Nashville, TN, or Columbia, SC may be considered for a hybrid schedule. Qualified candidates outside the local area will also be considered for a work from home schedule. You must have high-speed internet (non-satellite) and a private home office to work from home. Work hours are 8:00 a.m. to 4:30 p.m. CT, Monday through Friday.