Medicare Set-Aside Specialist
Remote
Full Time
Clinical Services
Experienced
Sanderson Firm specializes in Medicare Secondary Payer (MSP) services and is proud to be a woman-owned business. Our team of legal, clinical, and claims professionals has over 200 years of experience in the MSP industry, and we are proud to serve as trusted counsel and MSP compliance services vendor to some of the nation’s most well-recognized insurance carriers, self-insured companies, and third-party administrators, as well as smaller, regional insurance carriers and governmental entities.
- JOB DESCRIPTION:
- The Medicare Set-Aside Specialist is responsible for developing reports based upon guidelines provided by the Centers for Medicare and Medicaid Services outlining the future Medicare-covered expenses of individuals. The Specialist will assess the medical records of injured individuals to determine their future medical needs with associated costs and ensure the Medicare beneficiary has the necessary funds to be cared for throughout their life. This position will utilize clinical and nursing 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.
- JOB RESPONSIBILITIES:
- Review and summarize medical records, billing records, and medical and pharmacy payment histories, to outline an injured person’s past, current, and future treatment needs related to the accident.
- Understand and apply evidence based medical treatment guidelines, and/or CMS guidelines to future care recommendations.
- Identify and outline Medicare and Non-Medicare covered treatment.
- Identify and insert appropriate CPT, HCPCS, and ICD codes based on case specifics.
- Interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers.
- JOB SKILLS:
- Proficient in Microsoft Office Suite, including Word and Excel document preparation
- Effective multi-tasking skills in a high-volume environment.
- Excellent written and verbal communication skills.
- Ability to meet designated deadlines in a fast-paced production environment.
- Strong interpersonal, time management and organizational skills.
- Ability to work both independently and within a team environment.
- EDUCATION / EXPERIENCE:
- Graduate of accredited school of nursing, BSN preferred.
- Active Nursing License.
- Certification as a MSCC, SMSO, CLCP or CNLCP preferred.
- 5 or more years of writing allocations preferred.
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