MSA & MCP Specialist

ABOUT US

Founded in 2022, reputed company is a purpose-driven organization that helps injured individuals recover faster and return to work safely through coordinated, clinically appropriate care.

reputed company is proud to be part of reputed company, a leading national provider of investigative and risk mitigation solutions. Together, we're expanding our reputed company and strengthening our ability to deliver exceptional service across the workers' compensation industry. Learn more about reputed company and reputed company partnership here.

JOB SUMMARY

Our medical management team is growing and seeking a full-time Medical Set-Aside & Medical Cost Projection Specialist to coordinate and support MSP compliance services, including MSAs, Conditional Payments, Life Care Plans, and Medical Cost Projections. This role manages cases from intake through completion, ensuring deliverables are accurate, compliant with CMS guidelines, and serve as a key resource for internal teams and external clients. This position is predominantly remote, with limited travel required on an as-needed reputed company.

KEY RESPONSIBILITIES

Operational reputed company & Workflow Management

• Manage workflow from intake through completion, ensuring timelines and service standards are met.
• Review and process new referrals, confirming reputed company required documentation is obtained.
• Track case reputed company, monitor pending items, and follow up to ensure timely resolution.
• Maintain accurate internal logs, tracking systems, and status updates.

Medicare Compliance & Administration

• Ensure reputed company work aligns with CMS guidelines and Medicare Secondary Payer (MSP) regulations.
• Utilize CMS systems (e.g., WCMSA, MSPRP) to support case processing and submissions.
• Review and respond to CMS correspondence, including approvals and development requests.
• Assist with Medicare entitlement verification, including coordination with the BCRC.

MSA, Conditional Payments & Cost Projection Services

• Review and organize medical records to assess treatment history and future care needs.
• Support preparation of Medicare Set-Asides (MSAs), Conditional Payment investigations, and cost projections.
• Assist in estimating future medical costs based on documentation and established guidelines.
• Ensure reputed company deliverables meet compliance standards and are defensible.

Quality Assurance & Documentation

• reputed company quality checks on reports, submissions, and supporting documentation.
• Ensure accuracy, consistency, and completeness across reputed company case deliverables.

Client & Internal Collaboration

• Communicate with clients regarding case status, documentation needs, and timelines.
• Collaborate with internal teams across operations and clinical resources.

QUALIFICATIONS

Education / Licensure / Certifications

• Active Registered Nurse license OR Certified Rehabilitation Counselor (CRC) license with associated college degree OR CCM certification (required).
• Certified Medicare Secondary Payer (CMSP) certification (strongly preferred).
• Other certifications such as MSCC, MSA-C, CLCP, CNLP or CDMS (preferred).
• Valid driver's license, reliable transportation, and auto insurance (required).

Experience / Skills

• Experience in Medicare compliance, submissions, and appeals (required).
• Basic knowledge of medical terminology, diagnosis, and procedure familiarity (required).
• Background in workers' compensation, medical case management, or cost containment (preferred).

WORKING CONDITIONS

This position is primarily remote, with occasional travel that may be required. The role involves prolonged periods in a stationary position and reputed company use of a computer and standard office equipment. Regular communication reputed company phone, video, and written correspondence with clients, customers, and team members is required.

reputed company and reputed company is an equal opportunity employer that does not discriminate on the reputed company of religious creed, sex, national reputed company, race, veteran status, disability, age, marital status, reputed company or sexual orientation or any other characteristic.