Remote Medicare Set-Aside CMS Submission Specialist

Job Summary

Reporting to the Vice President of MSA Services, the MSA CMS Submission Specialist is responsible for accurately preparing submissions of Medicare Set-Aside allocations to the Centers for Medicare and Medicaid Services (CMS). This position requires a deep breadth of knowledge of the MSA process and a clear understanding of CMS's requirements for MSA submissions. Familiarity with medical treatment pricing, claims handling, claims settlement practices and meticulous attention to detail are required to ensure the accuracy of each submission package.

Position Specifics: Full-time; Non-Exempt position; working Monday through Friday (remote) with Pacific Standard Time schedule

The job responsibilities will include, but are not limited to:

~Accurately analyze complex medical treatment recommendations and assess appropriateness of usual and customary rates (UCR), or applicable workers' compensation fee schedules to verify medical treatment projections
~Reviews and prepares all documentation necessary to complete the submission of an MSA to CMS for review and approval
~Responsible for all subsequent communication with CMS including the submission of any additional information requests, rebuttals or appeals
~Participate in the quality assurance (QA) process from the initial assessment of medical treatment needs through to the completion of the MSA projection
~Ability to successfully manage extensive/complex caseloads and handle multiple submission requests simultaneously
~Communicate with claims and legal staff, medical providers and in some instances injured workers to obtain needed information and resolve submission-specific issues
~Communicate directly with clients, offering excellent customer service by responding to and answering their questions quickly and professionally
~Participate in ongoing training to enhance job skills and knowledge
~Other duties as assigned

This positions starts at $65,000-$75,000 annually based on experience, certifications, education and location. We offer an excellent employee benefit package, including medical, dental, and vision insurance, 401K, PTO and paid holidays.

Requirements:

~High School Diploma required; college degree preferred
~4+ years of experience in Workers' Compensation claims with customer service exposure
~Advanced knowledge of MSA process with specific experience in preparing CMS submission packages and handling correspondence with CMS
~Ability to read, analyze, and interpret technical procedures, medical reports, state laws and fee schedules, and legal opinions
~Excellent written and oral communication & interpersonal skills
~Excellent organization skills
~High comfort level with computers and computer programs (MS Word, MS Excel, email, etc.)
~Ability to meet deadlines in a high pressure, time sensitive environment
~Ability to lift up to 20 lbs.

Physical Requirements:

Candidate must be able to sit the majority of their day on duty. Candidate must be able to keyboard the majority of their day on duty. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm safe home office environment. Home office must be HIPAA compliant.

Requires DSL, fiber, or cable internet connection from home 100 Mbps preferred or better