Summary Working at CGS Administrators
CGS Administrators, LLC (CGS) is part of BCBSSC 's Celerian Group of companies and provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 8.7 million Medicare beneficiaries and 103,000 healthcare professionals nationwide.
This position supports our Durable Medical Equipment Medicare Administrative Contracts (DME MAC) for Jurisdictions B and C. These contracts are responsible for processing Medicare claims, managing appeals, providing customer service, conducting medical review activities, and recovering overpayments related to durable medical equipment.
The role reports directly to the DME MAC Program Managers and is part of the Program Management Office (PMO). The PMO team manages all government contract inquiries submitted to the PMO mailbox, partners with operational leaders to develop the monthly status report narrative, and ensures all communication is professionally written and aligned with government customer expectations.
This position will also lead operational workgroups and coordinate special projects as assigned.
Description Logistics: CGS -one of BlueCross BlueShield's South Carolina subsidiary companies.
Sponsorship: This position is not eligible for sponsorship now or in the future Work Environment :
- Typical office environment. Some travel between buildings and out of town.
Position Purpose: Creates and analyzes reports to support operations. Ensures correctness of analysis, and reports findings in a concise manner to senior management. Directly responsible for accuracy of data as financial and operational decisions are made based on the data provided.
This position will be responsible for monthly reporting to our government customer. Reports will consist of monthly status narratives and results, action plans and other deliverables due monthly, quarterly and annually. This includes management and oversight of operational reporting of workloads and financials.
What you'll do :
- Generates internal and external reports to support management in determining productivity and efficiencies of programs or operational processes. Revises existing reports and develops new reports based on changing methodologies.
- Analyzes reports to ensure accuracy and quality. Tracks and verifies all reporting statistics.
- Communicates and trains employees and managers on the complex database programs used to generate analytical data.
- Designs, codes, and maintains complex database programs for the extraction and analysis of data to support financial and operational decisions.
To Qualify for This Position, You'll Need: Required Education: - Bachelor's in a job-related field
Degree Equivalency: - Associates degree plus an extra 2 years job-related experience for a total of 6 years of required work experience (see "required work experience")
OR- 8 total years required work experience.
Required Work Experience: - 4 Years research and analysis experience.
Required Skills and Abilities:
- Strong organizational, customer service, communications, and analytical skills.
- Advanced experience using complex mathematical calculations and understand mathematical and statistical concepts.
- Knowledge of relevant computer support systems.
- Ability to train subordinate staff including provide assistance/guidance to staff in design/execution of reporting needs.
- Proven experience with report writing and technical requirements analysis, data and business process modeling/mapping, and methodology development.
- Strong understanding of relational database structures, theories, principles, and practices.
Required Software and Other Tools: - Advanced knowledge of Microsoft Office.
- Knowledge of programming languages across various software platforms, using DB2, SQL, and/or relational databases.
- Knowledge of tools such as Visual Basic and Macros useful in automating reporting processes.
We Prefer That You Have: - 10+ years of DME (Durable Medical Equipment) operations experience, including deep knowledge of Medicare program requirements, DMEPOS policies, and CMS operational standards.
- Extensive experience managing CMS escalations and complex inquiries, with a demonstrated ability to resolve high-visibility and sensitive issues.
- Minimum 5 years leading the CMS Monthly Status Report (MSR) process, including drafting, data validation, narrative development, and on-time submission.
- Minimum 5 years managing the Award Fee Self-Assessment process, including analysis, narrative preparation, and coordination across operational teams.
- Proven experience leading or facilitating DME-related Medicare workgroups, steering discussions, developing recommendations, and driving cross-functional alignment.
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 access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
Our comprehensive benefits package includes:
- Subsidized health plans, dental and vision coverage
- 401K retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- Nine paid holidays
- On-site cafeterias and fitness centers in major locations
- Wellness program and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Employee Assistance
- Discounts to movies, theaters, zoos, theme parks and more
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. Management will be conducting interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.
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 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. Here's more information .
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