Job Type
Part-time
Description
Reporting to the President, the Medicare Set-Aside (MSA) Specialist is responsible for evaluating, preparing, and submitting Medicare Set-Aside allocations in compliance with CMS guidelines and applicable state and federal regulations. This role ensures the protection of Medicare’s interests in workers’ compensation and liability settlements, collaborating with internal teams, clients, legal counsel, and medical professionals to deliver compliant, timely, and accurate MSA reports.
Position Specifics: Non-Exempt position working Part-Time Monday through Friday, in office or remotely.
Please NOTE: This position requires previous Medicare Set-Aside experience.
Key Responsibilities
- Review and edit initial medical abstraction and MSA future medical allocation to ensure the MSA allocation meets both quality standards and client expectations. Includes review of medical records, billing statements, case notes, and pharmacy histories to develop accurate MSA allocation.
- Analyze and apply CMS guidelines, statutes, and state regulations related to Medicare Secondary Payer compliance.
- Support CMS Submission Specialists to ensure MSA packages are prepared accurately for submission to CMS. Requires detailed understanding of all CMS submission requirements, including workload thresholds and settlement details.
- Communicate with claims professionals, legal teams, and clients to gather necessary data for both case completion and case resolution.
- Respond to client inquiries and provide expert guidance on MSA processes, pricing, and submission requirements.
- Coordinate conditional payment searches, lien resolution, and related Medicare compliance services as needed.
- Maintain accurate documentation, records, and reports in accordance with organizational and regulatory requirements.
- Stay current on CMS policy changes and industry trends to ensure ongoing compliance and best practices.
Benefits
- Base hourly rate
- 401K
- Equipment provided
- Monthly internet stipend
Requirements
Required:
- Experience in a similar role as Medicare Set Aside Specialist, including CMS submission processes and conditional payment resolutions, as well as an understanding of workers’ compensation claims process, liability claims, and medical case management.
- Strong knowledge of Medicare Secondary Payer Act and CMS MSA guidelines.
- Proficiency in medical terminology and interpreting medical records.
- Excellent written and verbal communication skills.
- Experience communicating and negotiating effectively with Centers for Medicare & Medicaid Services (CMS), attorneys, and other stakeholders.
- Strong analytical, reporting, and decision-making skills.
- Experience managing workflows, balancing multiple priorities, and meeting time-sensitive deadlines.
Preferred:
- Certified Medicare Set-Aside Consultant (CMSP, MSCC, or equivalent certification).
- Background in nursing, medical coding, or legal support is a plus.
Work Environment:
- Remote.
- Standard office hours with occasional client or team meetings across time zones.
- Must maintain confidentiality and comply with HIPAA and data security protocols.
*Requires DSL, fiber, or cable internet connection from home, 100 Mbps preferred or better *
