Medicare Set-Aside (MSA) Analyst
Summary
Performs file reviews, prepares future medical cost projections and Medicare Set-Aside allocation reports. Interacts regularly with customers providing excellent customer service and communicates daily with internal teams at IMPAXX.
Essential Duties and Functions
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- Reviews and analyzes medical records, claim file documents, hearing orders, and depositions for preparation of MSA allocation reports.
- Researches Medicare coverage and jurisdictional and regulatory guidelines.
- Communicates frequently and effectively with Team Leader, Coding Team, Clinical Director, and Referral Coordinators.
- Reviews resources on the Analyst portal and IMPAXX Intranet frequently, including customer handling instructions.
- Ensures thorough and accurate file documentation including data entered into IMPAXX’s proprietary case management system, MyConnect.
- Prepares future medical cost projections and MSA allocation reports.
- Enters critical data into the medical tab for preparation of allocation.
- Communicates with customer as needed for clarification of outstanding information necessary for completing an MSA.
- Provides rationale for allocation and identifies mitigation opportunities.
- Reviews auto-MyConnect pricing function to ensure accuracy.
- Provides feedback for possible improvements to workflow processes within the MyConnect system.
- Proofreads calculations and summaries generated.
- Delivers allocation report to customer identifying exposure and mitigation opportunities.
- Responds to direct inquiries from customer regarding allocations delivered and addresses MSP compliance questions from customer (or directs them to the appropriate team).
- Reviews, analyzes, and communicates CMS counter opinions as assigned.
- Produces a minimum of 1.2 allocation reports per day based on a fiscal month end average.
- Maintains confidentiality and security of all medical records received and reviewed.
- Performs other duties as assigned.
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
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- 3-5 years of experience with Workers’ Compensation or Liability claims
- Proficiency in MS Office Suite
- Accurate typing skills
- Excellent telephone demeanor
- Ability to work additional hours, or a flexible schedule, based on occasional increased work demands
- One of the following (multiple areas preferred):
- Juris Doctorate (JD) degree
- Bachelor’s degree in Nursing, Registered Nurse (RN) License with 3-5 years clinical nursing experience
- Paralegal certificate
- 3-5 years of claims management experience
- MSA Analyst experience
The base salary range for this position is $55,000 – $90,000. This pay range provided is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, acquired certifications/ degrees, geography, merit and/or budget for the role. The position is also eligible for monthly bonuses on top of the base salary, depending on production.
Teammate Benefits & Total Well-Being
We go beyond standard benefits, focusing on the total well-being of our teammates, including:
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- Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
- Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
- Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
- Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.
Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations.
The Power To Be Yourself
As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.