Available Position (Company name withheld)

Medicare Set-Aside Specialist

United States
Full Time
Experienced
  1. JOB DESCRIPTION:

The Medicare Set-Aside Specialist is responsible for developing future medical allocation reports based upon both evidence-based medical guidelines and guidance published by the Centers for Medicare and Medicaid Services.  This position will utilize professional assessment and clinical skills to develop Medical Cost Projections and Medicare Set-Asides for workers' compensation and liability settlements based on published standards of practice. Experience with Evidence Based Medicare Set-Asides (EBMSAs) is strongly preferred. 
 
  1. JOB RESPONSIBILITIES:
    1. Review and analyze medical records, billing/payment records, and pharmacy payment histories, to identify an injured person’s past, current, and future treatment needs related to the accident.
    2. Prepare medical record summary narrative that is clear and concise.
    3. Understand and apply evidence based medical treatment guidelines, and/or CMS guidelines to future care recommendations.
    4. Document rationale for findings and analysis of the case.
    5. Identify and outline Medicare and Non-Medicare covered treatment.
    6. Identify and insert appropriate CPT, HCPCS, and ICD codes based on case specifics.
    7. Interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers.
    8. Maintain established company quality standards.
    9. Meet weekly production goals.
  2. JOB SKILLS:
    1. Proficient in Microsoft Office Suite, including Word and Excel document preparation.
    2. Effective multi-tasking skills in a high-volume environment.
    3. Excellent written and verbal communication skills.
    4. Ability to meet designated deadlines in a fast-paced production environment.
    5. Strong interpersonal, time management and organizational skills.
    6. Ability to work both independently and within a team environment.
    7. Strong attention to detail.
  3. EDUCATION / EXPERIENCE (two or more of the following):
    1. 5 or more years of MSA experience.
    2. Graduate of accredited school of nursing (BSN/LPN) or Registered Nurse (RN) license.
    3. Certification as a MSACP, MSCC, CMSP, CLCP or CNLCP.
    4. 3-5 years case management, utilization review  or claims management experience.
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