Conducts clinical reviews and research for complex appeal or retrospective review requests to determine medical necessity. Documents decisions in compliance with applicable regulations and standards within mandated timeframes.
CGS Administrators, LLC
5 Remote Job Openings at CGS Administrators, LLC
RN Appeals Analyst Medicare Part B - CGS
CGS Administrators, LLC
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Full Time
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18 days ago
CGS Administrators, LLC
Research and analyze complex appeal or retrospective review requests to determine if services meet medical necessity guidelines. Document decisions accurately and timely in compliance with applicable regulations and standards.
Conducts comprehensive financial, compliance, and operational audits to evaluate internal controls and identify business risks. Prepares detailed audit reports and recommendations for executive management to improve corporate processes and prevent fraud.
Medicare Cost Report Auditor III
CGS Administrators, LLC
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Full Time
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a month ago
CGS Administrators, LLC
Conducts comprehensive financial, compliance, and operational audits to evaluate internal controls and identify business risks. Prepares detailed audit reports and recommendations for executive management to improve corporate processes and ensure regulatory compliance.
Chief Medical Officer (Medicare Policy)
CGS Administrators, LLC
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Full Time
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a month ago
CGS Administrators, LLC
Provides administrative oversight to medical staff and leads the generation and revision of medical policies. Analyzes utilization data and conducts research on new medical procedures to guide operational policies and claim adjudication.
