Southcarolinablues
Overpayment Recovery Analyst - CGS
Southcarolinablues, Nashville, Tennessee, United States, 37247
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Overpayment Recovery Analyst - CGS page is loaded Overpayment Recovery Analyst - CGS Apply remote type Hybrid locations Nashville, Tennessee time type Full time posted on Posted 2 Days Ago time left to apply End Date: August 25, 2025 (30+ days left to apply) job requisition id R1045786 Summary Identifies, researches, and investigates providers for aberrant and abusive billing practices against the company and its subsidiaries. Analyzes hospital accounting records for overpayments and fraudulent billing to the corporation. Identify potential fraud and abuse situations through document review and analysis. Description What You’ll Do. Conducts onsite or desk audits of hospitals and provider facilities to identify overpayments and compliance with government regulations, which may include Medicare Secondary Payer (MSP) regulations. Analyzes provider contracts to determine the proper reimbursement of inpatient and outpatient benefit payments and calculates correct refunds. Performs comprehensive review and responds to complex inquiries of all varieties of provider facilities. This may include the review, trending, analysis, and executive report of all claims actions. Identifies potential fraud and abuse situations and refers documented findings to appropriate area for investigation. Develops comprehensive financial strategies and master audit programs for hospitals and provider reviews. Conducts outreach workshops and training sessions for appropriate groups to focus on problem areas relating to government regulations and billing issues. May coordinate research and reporting functions for the MSP prepay claims department. Required Education: Bachelor’s degree in Business Administration or other related field
OR Four years billing/reimbursement, hospital finance/overpayment recovery, or MSP experience. Required Work Experience: Six years of experience with health insurance claims and/or hospital billing procedures and/or MSP. Required Skills and Abilities: Analyzes provider contracts. Conducts provider compliance audits. Identifies potential fraud situations. Makes recommendations for corrective actions. Produces monthly summary reports. Required Software and Tools: Microsoft Office. Work Environment: Typical office environment. 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 mycareer.help@bcbssc.com or call 800-288-2227, 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 moreinformation . Some states have required notifications. Here's more information .
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by submitting your resume and contact information and we will reach out if we find a good fit. About Us
Welcome
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. Join Us
If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!
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Overpayment Recovery Analyst - CGS page is loaded Overpayment Recovery Analyst - CGS Apply remote type Hybrid locations Nashville, Tennessee time type Full time posted on Posted 2 Days Ago time left to apply End Date: August 25, 2025 (30+ days left to apply) job requisition id R1045786 Summary Identifies, researches, and investigates providers for aberrant and abusive billing practices against the company and its subsidiaries. Analyzes hospital accounting records for overpayments and fraudulent billing to the corporation. Identify potential fraud and abuse situations through document review and analysis. Description What You’ll Do. Conducts onsite or desk audits of hospitals and provider facilities to identify overpayments and compliance with government regulations, which may include Medicare Secondary Payer (MSP) regulations. Analyzes provider contracts to determine the proper reimbursement of inpatient and outpatient benefit payments and calculates correct refunds. Performs comprehensive review and responds to complex inquiries of all varieties of provider facilities. This may include the review, trending, analysis, and executive report of all claims actions. Identifies potential fraud and abuse situations and refers documented findings to appropriate area for investigation. Develops comprehensive financial strategies and master audit programs for hospitals and provider reviews. Conducts outreach workshops and training sessions for appropriate groups to focus on problem areas relating to government regulations and billing issues. May coordinate research and reporting functions for the MSP prepay claims department. Required Education: Bachelor’s degree in Business Administration or other related field
OR Four years billing/reimbursement, hospital finance/overpayment recovery, or MSP experience. Required Work Experience: Six years of experience with health insurance claims and/or hospital billing procedures and/or MSP. Required Skills and Abilities: Analyzes provider contracts. Conducts provider compliance audits. Identifies potential fraud situations. Makes recommendations for corrective actions. Produces monthly summary reports. Required Software and Tools: Microsoft Office. Work Environment: Typical office environment. 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 mycareer.help@bcbssc.com or call 800-288-2227, 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 moreinformation . Some states have required notifications. Here's more information .
If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to
Join Our Talent Community
by submitting your resume and contact information and we will reach out if we find a good fit. About Us
Welcome
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. Join Us
If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!
#J-18808-Ljbffr