Medicare Set-Aside (MSA) Analyst

Summary

Performs file reviews, prepares future medical cost projections and Medicare Set-aside Allocation reports. Interacts regularly with the Quality Management Team and Referral Team.

Essential Duties and Functions

  • Performs file reviews
  • Researches Medicare coverage issues
  • Communicates frequently an effectively with Quality Management Team and Referral Coordinators
  • Reviews resources on the Analyst iPortal frequently, including customer handling instructions
  • Ensures thorough and accurate file documentation
  • Prepares future medical cost projections and Medicare Set-aside Allocation reports
  • Provides rationale for allocation and identify mitigation opportunities
  • Reviews auto-MSA function, adding/ deleting treatment items as appropriate
  • Proofreads both calculation and summary generated

Qualifications and Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Required Qualifications

  • 3-5 years of experience with Workers’ Compensation or Liability claims
  • One of the following (multiple areas preferred):
    • Juris Doctorate (JD) (preferred)
    •  Bachelor Degree Nursing, Registered Nurse (RN) License with 3-5 years clinical nursing experience and certifications/ licensing as outline below. (preferred)
    • Paralegal Certificate
    • Claims management experience – three to five years
    • MSA Analyst experience – three to five years
  • Proficiency with MS Office Suite
  • Accurate typing skills and proficiency
  • Excellent telephone demeanor
  • Ability to work additional hours or a flexible schedule based on occasional increased work demands

Certificates or Licenses

  • Registered Nurses: Current RN license and current credentials in at least one of the following CDMS, CLNC, CCMC,CRRN, QRP, LNCC, CIC, LHRM, CHCQM, LCP, CLCP
  • MSCC or ability to obtain MSCC within 90 days of employment

This job description is not meant to be an all-inclusive statement of the duties of the position listed above.

Ready to apply? Email Team Resources.