Employment Opportunities

 

Information for NAMSAP members interested in obtaining employment in the Medicare Set-Aside Industry.

 

Full Time Medicare Set-Aside Allocation Specialist

Responsible for developing Medicare Set-Aside Allocations in accordance with CMS standards. Position requires knowledge of medical treatment protocols and related medical costs for all forms of treatment and pharmaceuticals. Candidates must have excellent computer skills, demonstrate outstanding verbal and written communication skills and be able to problem solve. Candidate must be willing to work collaboratively with MSA team.

Qualifications:  RN, Certified Medicare Set-Aside Consultant ((MSCC) or Certified Life Care Planner(CNLP/CLCP) with 3-5 years case management experience preferred. Fax resumes with salary requirements to MCMCllc at: 866-557-6290, attention MSA. www.MCMCllc.com

 

MEDALLOCATORS PLANNER POSITION
MedAllocators is currently looking for full time experienced RN’s to become part of our team in preparing Medicare Set-Asides, Medical Cost Projections, and Life Care Plans. Responsibilities include a complete review of medical records that results in a comprehensive analysis of future treatment recommendations.  We offer a competitive compensation and benefits package.
 
Job Requirements:

Current RN License
Current CLCP or CNLCP Certification
Current MSCC Certification
Knowledge of Workers’ Compensation and Medicare Guidelines
 
If you are interested in pursuing career opportunities with MedAllocators, Inc. please submit your resume to Janet Bailey and/or Pat Smith at jbailey@medallocators.com and psmith@medallocators.com

 

Director, Medical Support Services

The Hartford Financial Services Group

 

WHY JOIN THE HARTFORD?

As a global leader in insurance, asset management and financial service products, we offer professionals every possibility for growth. 

And whether we’re helping customers or building careers, we’re experts at creating the kind of advantages that help people reach their goals.

 

WHAT ARE THE RESPONSIBILITIES OF THE POSITION?

The Medical Support Services Director serves as the critical link between Medical Practices and Support and the functional lines of

business in the P&C Company regarding clinical management and reserving for Large Loss and Complex Medical Claims.  This position

also manages the production and submission of Medicare Set Aside Allocations.  As such, this individual works with the Vice President,

Medical Practices and Support / Medical Director to develop and implement national strategies to align Large Loss and Complex Claim

medical services across all the lines of the P&C business.  This involves identifying new medical product and service needs for the P&C

lines of business and developing or improving products to serve those needs.

 

Working with the Corporate Medical Director / Vice President for Medical Practices and Support, actively work to develop a national

strategy for incorporating medical services into the liability management activities of the P&C Company.  Take primary responsibility

for implementing this strategy within the Claims organization and across all business lines.  Working with representatives of the staff

legal and large loss legal teams, identify the needs nationally of this group for medical services and develop a plan including staffing

proposals to meet those needs. 

 

Manage staff that produces and submits MSA reports.  Lead the development and implementation of process improvements for current

MSA production activities including working with claims practices to generate national guidance to improve MSA production processes.

Coordinate with Medical Programs to support oversight of MSA vendors.

 

Lead the effort for continuous improvements to the current MSA submission process model including the creation of a measurement tool

to accurately quantify the risks and benefits associated with MSA submission process guarantees.  Work closely with the Large Loss

Claims Organization to evaluate the value of implementing such a process

 

Design and manage Large Loss medical file review in support of the Home Office Worker’s Compensation Large Loss Unit.  Provide

leadership to the Home Office Large Loss medical review process.  Identify opportunities for improving quality and customer service.

 

Major current responsibilities – Worker’s Compensation Claims:

• Manages a staff of 8 professionals and 1 administrative support person
• Manages Medical Consulting to improve claim management, claim settlement assessment and reserving accuracy for Workers’ Compensation
• Manages the Medicare Set Aside Allocation process including identification of claims appropriate for MSA, producing and submitting MSA reports in support of Workers’ Compensation claim settlement.

 

Added Responsibilities - Liability Claims:

• Managing medical consulting to improve claim settlement assessment and reserving accuracy for Bodily Injury claims
• Support for claims in litigation including consultation support for Staff Legal and claims staff involved in litigated claims including

- Initial claim review

            - Causality assessment

            - Assessment of medical necessity for medical care

            - Litigation strategy development

            - Litigation support

            - Expert witness identification

 

Added Responsibilities—Integrating Best Practices:

• Identify process gaps and improvement opportunities at all levels of the medical-legal claims management process
• Design and implement best practices in medical-legal claim management across all lines of the P & C business utilizing these findings to improve process and reduce expense
• Leverage the knowledge and insights gained in the management of medical legal claims across the business lines to increase efficiencies and spread innovation

 

WHAT ARE THE QUALIFICATIONS?

• Baccalaureate Degree in a Business or Medical field required
• Proven success as a manager and exceptional leader required
• Must have 5 years experience working in the Worker’s Compensation Industry
• Advanced degree in medical or business-related field preferred (e.g., MBA, MSN, MPH, etc.)
• RN and/or BSN preferred
• Certified Case Manager and/or Certified Life Care Planner preferred
• MSA production experience and knowledge and experience regarding the Medicare Submission process preferred
• Skilled communicator
• Understands and drives quality performance – familiar with tools such as Six Sigma
• Creative, innovative and pro-active in identifying process problems and designing and implementing change  
• Computer and data analysis skills a strong plus
• Excellent Customer Service skills

 

Please email resumes to Hilary Sams - Hilary.Sams@thehartford.com

This position resides in our Hartford, Connecticut office.

 

 

 

Medicare Set-Aside Analyst

Xchanging has an opening for a Medicare Set-Aside Analyst in our Carrollton, Texas office. The job code for this position is R9328.

This individual will be responsible for the completion of the Medicare Set-Aside Analysis, which requires a knowledge of Medicare

coverage, medical terminology, medical treatment codes, ability to interpret medical records, analyze treatment plans, prepare pricing

of future medical care, including diagnostics, prescription medications,  surgical procedures and then compose the analysis based upon

logical conclusions derived from the medical records. This individual will also be responsible for submission of the Medicare Set-Aside

Analysis to the Centers for Medicare/ Medicaid Services. The submission letter must be based upon sound medical judgments presented

in a logical convincing and defensible manner.

The MSA Analyst will be responsible for securing the information necessary to compose the analysis. This includes securing medical

records, payment history from the client as well as identifying co – morbidity medical issues to secure age ratings. The analyst will

be responsible for answering all questions and concerns as to how the MSA figures were arrived at.

Primary responsibilities for this position include:

• Interact with client in the development of Medicare Set-Aside files
• Analyze and review medical records in conjunction with medical payment history
• Formulate analysis for Medicare/CMS consideration based upon future medical projections
• Provide detailed and logical analysis of data to client as well as provide submissions to local CMS offices for settlement
• Negotiate with CMS office when disagreement of value occurs 

Job Requirements:

• College degree or equivalent
• Medical background, RN designation a plus
• Workers’ Compensation claim background a plus
• Two years experience as an MSA Analyst
• Good written and oral communication skills
• Good math skills
• Self starter
• Good analytical skills
• Computer skills in Word, Excel

Qualified candidates will have:

• College degree or equivalent business experience
• Minimum 3 years in the field of healthcare
• Group health/workers’ compensation claim experience
• Experience with Medicare/CMS a plus

TO APPLY:
Please visit our website:

http://www.cambridgeworldwide.com/cambridge.html?http://www.cambridgeworldwide.com/Careers_US_Search.html

Equal Opportunity Employer. M/F/D/V

 

 

 

 

STAFF COUNSEL

Gould & Lamb is looking for an attorney on our staff focusing exclusively on Federal issues arising under the Medicare Secondary Payer statute. Our qualifications include the following:

• Extensive litigation experience in workers’ compensation and liability claims
• Extensive experience handling SSDI and Second Injury Fund Claims
• Extensive experience handling MSPRC settlement work

SUPERVISORY RESPONSIBILITIES: 
There are no supervisory responsibilities with this role.

OTHER KNOWLEDGE, SKILLS and ABILITIES:
High energy level, comfortable performing multifaceted projects in conjunction with day-to-day activities.
Demonstrated strong interpersonal skills.  Ability to get along with diverse personalities, tactful, flexible. 
Ability to establish credibility and be decisive, while being able to recognize and support the Company's preferences and priorities.
Ability to work independently but the experience to identify the need to partner at critical junctures in any business decision making activity.
Ability to prioritize activities and projects.  Skilled at time management and attention to detail. Refined sense of urgency.
Proficiency with Microsoft Office Suite with advanced skills in Excel.
Ability to maintain the highest level of discretion, diplomacy and confidentiality.

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear in order to gather and present information.  While performing the duties of this job, the employee is regularly subjected to changing priorities, time pressures and constraints, and a moderate level of job related stress.

WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

QUALIFICATION REQUIREMENTS: 
Job requires travel delivering presentations related to the MSP statute to clients and conference venues, and article-writing for company and industry publications. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

EDUCATION and/or EXPERIENCE:
Law Degree, FL Law License preferred, but not required; and working knowledge of Medicare Secondary Payer (MSP) Statute.  Minimum 5 years experience with MSPRC Settlement work.

Please send resumes to:     Ann.Aldrich@gouldandlamb.com

Fax:     941-792-9179

 

 

 

Medicare Compliance Nurse

CLAIM YOUR FUTURE AS A GREAT PERFORMER!

Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims 
Management Services the place where great people can do great things for clients while maximizing their 
career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability 
and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 
2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice 
designation. Come be a part of our team and "Claim Your Future."

PRIMARY PURPOSE:  To prepare and draft Medicare Set-Asides (MSAs), Medical Cost Projects (MCPs) and 
related products.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
1.    Prepares and drafts Medicare Set-Asides (MSAs), Medical Cost Projects (MCPs) and related products.
2.    Reviews medical claims and legal records; provides concise written reports depicting past medical care, 
current medical status and anticipated future medical care in MS Word and Excel format; creates reports 
documenting comprehensive and detailed medical summaries, evaluation of past treatment procedures, and 
prediction and accurate pricing of future treatment plan(s).
3.    Provides consulting services for assigned claims examiner and defense counsel related to Medicare and 
medical issues including, but not limited to, advising how to reduce an MSA, explanation of the MSA process, 
and discussion of specific medical procedures.
4.    Provides required training to examiners handling medical/Medicare issues related to general liability and 
workers’ compensation.
5.    Creates and implements custom solutions to Medicare related problems including formulating solutions 
and communicating effectively verbally and in writing with healthcare providers, claims examiners and 
defense counsel to implement solutions.
6.    Identifies and resolves issues related to pricing MSAs and MCPs.
7.    Ensures quality, medical soundness, accuracy and timely delivery of MSA allocations and MCPs.
8.    Provides changes/updates to the MSA document/process as indicated within Medicare guidelines and 
industry standards to provide clients with the best MSA project available.
9.    Maintains appropriate file documentation.
10.  Maintains comprehensive knowledge of pricing trends for MSAs; incorporates trends into MSA and MCP 
reports.
11.  Maintains thorough knowledge of state laws to ensure proper compliance. 

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
1.    Performs other duties as assigned.
2.    Supports the total performance management initiative.  
3.    Travels as required.

QUALIFICATIONS
Education & Licensing
BS/BA degree or equivalent preferred. LVN or LPN and CPUR or equivalent certification required. Medicare 
Set-Aside Consultant Certified (MSCC) certification required.  

Experience
Seven (7) years of related experience required to include two (2) years of MSA writing experience.  AS/AA 
degree may substitute for one (1) year of experience; BS/BA degree may substitute for two (2) years 
experience; MS/MA degree may substitute for three (3) years experience.

Skills & Knowledge
·        Thorough knowledge of MSA creation and pricing
·        Proficiency in medical research online and in written text
·        Excellent oral and written communication skills
·        PC literate, including Microsoft Office products
·        Excellent mathematical skills
·        Analytical and interpretive skills
·        Strong organizational skills
·        Ability to work in a team environment
·        Ability to meet or exceed Performance Competencies

TO APPLY:
Please visit https://www.sedgwickcms.com/careerresources/careersearch.aspx
Once in the career center please enter “Medicare” in the keywords box.
No phone calls
No staffing agencies

 

 

 

National Sales Representative - Medicare
Position Summary
Determine and execute effective sales strategies in order to identify new business opportunities.  Maintain 
customer relationships and resolve customer service issues.  Participate in marketing initiatives and 
networking events in order to develop contacts, and aggressively pursue contacts in order to obtain new 
business.

This position will work remotely on a flexible schedule and reports to the Medicare Practice Group Leader.  
Position offers a base salary plus commission.

Essential Job Functions

• Maintain the highest level of professionalism at all times when interacting with internal and external 
  customers. Demonstrate a positive attitude and commitment to quality customer service.
• Contribute to a positive team environment by demonstrating a strong work ethic, effectively
  communicating with others, and proactively anticipating attorney and client needs.
• Provide periodic file and business reviews in conjunction with attorneys, employers, adjusters, nurse case
  managers, and claims supervisors.
• Maintain client relationships by coordinating services and effectively resolving customer service issues.
• Develop competitive sales strategies through research and prospecting.
• Stay abreast of industry and competitive trends, and utilize that knowledge in a progressive and proactive
  manner in obtaining new business.
• Regularly interact with a variety of others including internal attorneys and staff, adjusters, claims
  supervisors, outside attorneys, employers, and insurance professionals.
• Identify opportunities and pursue new business from high-volume accounts, dormant accounts, and
  potential accounts.
• Participate in marketing initiatives such as business services presentations, trade show exhibits,
  networking, attending Workers Compensation Association meetings, and other events.
• Keep accurate records regarding sales, leads, etc. Analyze data in order to document trends, results,
  opportunities, and prepare status reports as required.

Complete special projects and other assignments as requested by supervisor or other members of
firm management.

Requirements

• Education: Bachelor’s Degree in Business, Marketing, Communication, or other relevant field.
• Experience: At least five years sales experience in a Medicare Set-Aside and/or Workers Compensation
  environment. Additional sales experience preferred.
• Knowledge, Skills and Abilities:  Superior communication, presentation, and interpersonal skills. 
  Extremely professional, polished, and possessing strong business acumen.  Must be results oriented with
  good follow up/follow through. Demonstrated ability to take initiative and complete projects.  Adaptable
  and able to prioritize work.  Effective planning and organizational skills.  Ability to effectively interact with
  all organizational levels both internally and externally.  Able to work independently.  
  Computer literate and ability to use basic desktop applications including MS Office and Internet, as well as
  understanding of databases.  Must have valid driver’s license and ability to travel on a frequent basis.

SUBMIT RESUME AND SALARY REQUIREMENT TO:
Amy J. Reiss
Director of Human Resources
Burns White & Hickton LLC
Four Northshore Center
106 Isabella Street
Pittsburgh, PA 15212
jobs@bwhllc.com
No phone calls please
No placement agencies

 

 

 

Product Manager for Ancillary Services/Specialty Networks

Responsible for the product planning and 
execution throughout the product lifecycle

• Minimum of  5 years experience as a Product Manager
• Demonstrated success defining and launching successful products
• 3+ years of experience in a job in the Workers’ Compensation
• 3+ years of experience in Ancillary Health market
• Bachelor's degree (MBA preferred)
• Excellent teamwork skills
• Must be able to travel.
• Strong oral, written, and communication skills, as position requires frequent presentations and written
  reports preparation

Please resume and salary requirements to hr@cypresscare.com

 

 

 

MSA Nurse Consultant
Valid Registered Nurse license
MSCC Certification
Minimum of 2 years experience with Medicare Set-Aside Development
Proficient in Math, Microsoft Word and Excel
Detail Oriented
Strong written English communication skills
Working knowledge of Medicare Guidelines
Experience in the Workers’ Compensation Area, a plus
 
Please send resume, sanitized sample of your work product along with compensation requirements to: 
Lisa@MSASpecialists.com

 

 

 

MSA Nurse QA Director
We are seeking a qualified individual with the below listed credentials and experience.
Valid Registered Nurse license
MSCC Certification
Strong written English communication skills
Minimum of 3 years experience with Medicare Set-Aside Development
Minimum of 3 years of quality assurance experience
Proficient in Math, Microsoft Word and Excel
Detail Oriented
Working knowledge of Medicare Guidelines
Experience in the Workers’ Compensation Area, a plus
 
Please send resume, sanitized sample of your work product along with compensation requirements to: 
Lisa@MSASpecailists.com

 

 

 

MSA Nurse Case Manager
Private Rehab Company seeking qualified Medicare Set Aside Allocation (MSA) specialist.
Ideal candidate must have

• valid RN license
• Bachelors Degree and MSA certification
• Prior experience completing all aspects of MSA from creation to submission and 2 years MSA experience.
• Life Care planning experience and certification a plus. 
• Must be Customer service oriented,
• Possess excellent interpersonal, oral & written communication skills, including report preparation
• Proficient in Microsoft Word, Excel, Access and Outlook.
• Be able to work independently, within tight deadlines, be able to adapt and remain open to change
  priorities as needed.

send resume with salary requirements to
Hally Ley, hally.ley@procura-inc.com
Please no phone call inquiries

 

 

 

Medicare Set-Aside Allocation Nurse

The Medicare Set-Aside Allocation Nurse performs an extensive review of medical, claims and legal records 
and prepares an MSA within the specified time frame.  This is a full-time position in our Oviedo, Florida office 
requiring a minimum of 40 work hours per week.

Required: 

Minimum of 3 years of nursing experience, extensive knowledge of Medicare guidelines, the Secondary Payer 
Statute, and Medicare Set-Aside Allocations.  Experience in Case Management of either Workers’ Compensation
and/or Disability Management cases.  Medicare Set-Aside Consultant – Certified (MSCC) & Certified Case 
Manager (CCM) required.

Preferred:

Certified Legal Nurse Consultant (CLNC), Certified Rehabilitation Registered Nurse (CRRN), or Certified Life
Care Planner (CLCP) preferred.
Please visit our website for a detailed job description, www.medivest.com
Resumes can be emailed to Jenny Arbelaez, jarbelaez@medivest.com

 

 

 

Northern California Account Executive
Due to continued success in California MedAllocators, Inc. is hiring an Account Executive for Northern 
California.  Position offers a competitive salary and a generous commission program.  
 
We seek a candidate with 2 years minimum experience in workers compensation sales, marketing.
A proven, positive track record with upward goal achievement is very desirable.

In addition, this candidate will possess:

• outstanding customer service delivery, second to none
• exemplary professional sales presentation skills
• a positive attitude with excellence in verbal and written communication
• strong organizational, time management and computer literacy skills
• ability to work autonomously and as a team player
• motivated to represent the fastest growing, dynamic company in the industry

Please contact www.medallocators.com or Chris Carpenter at ccarpenter@medallocators.com to apply.

 

 

 

MSA Regional Account Representatives

PMSI MSA Services has opportunities for MSA Regional Account Representatives. The Regional Account 
Representative is responsible to meet or exceed the MSA Services revenue plan for assigned territory through 
new business development and maintenance of existing customer relationships. 

Positions are currently available in the following areas:

• Southern California
• New England
• Maryland/Virginia
• Arizona/Utah
• Colorado/New Mexico
• Illinois
• MN,WI,SD, or IA
• New Jersey
• New York (Upstate)
• New York City/Long Island
• NH, VT, ME
• Northern California
• Ohio
• Oklahoma/Kansas
• Texas (South)
• South Carolina
• Pennsylvania

Candidates will need to reside in the territory which they support.

Minimum Position Requirements

Education
Required: Bachelor’s Degree in Business Administration, Bachelor’s of Science or equivalent experience

Work Experience:
Required: 2+ years of prior sales experience, 1 year experience in workers’ compensation.
Desired: 3-5 years of sales experience in workers’ compensation environment

Skills/Knowledge
Required: Basic to intermediate computer skills, MS Office Suite (Word, Excel), sales process methodology
Desired: Client Profiles, Workers’ Compensation industry background

Licenses/Certifications
Required: Valid driver’s license with good driving record, ability to travel

Behavior Competencies
Requires: Results Orientation, Adaptability, Presentation Skills, Oral & Written Communication, Customer

Service, Listening Skills, Planning/Organizing, Impact, Tenacity, Resiliency and Persuasiveness.

Responsibilities

• Works with Regional Sales Manager to achieve revenue goals by providing quarterly file and business
  reviews in conjunction with Lawyers, Employers, Adjusters, Nurse Case Managers and Claims Supervisors.
• Works with Regional Sales Manager and Operations to maintain client relationships by coordinating
  services and effectively resolving customer service issues.
• Works with Regional Sales Manager to develop strategies to keep ahead of the competition through
  research and prospecting.
• Expands existing business through a combination of telephone calls and in-person visit to high volume
  accounts, dormant accounts, and potential accounts for increased business prospects. Daily visits to
  clients and potential clients to pick up and copy claim files.
• Works with Regional Sales Manager and Operations on the implementation of new business and in
  respective region.
• Works with Regional Sales Manager to conduct marketing efforts through business services presentations
  with healthcare providers, insurance carriers, TPA’s and employer groups by participating in trade show
  exhibits and networking by attending monthly Worker’s Compensation Association meetings.
• Works with Regional Sales Manager to complete all sales status reports in a timely manner and reviews
  them on a regular basis.  
• Responsible for using available sales technology and tools provided by PMSI Corporate Sales to manage
  lead and report generation. 
• Works with Regional Sales Manager on special projects as assigned.

This position reports to the Regional Sales Manager
Applications may be submitted online at the Careers section of the PMSI website www.pmsionline.com

 

 

 

Crowe Paradis Services Corporation (CPSC) is looking to fill the following positions. To learn more about CPSC, please visit our website at www.cpscmsa.com. 
  
Sales Account Manager – Midwest
Crowe Paradis Services Corporation (CPSC) has an immediate opening for a Midwest Territory Account
Manager.  This position offers a competitive salary and bonus structure with no cap on earning potential.

Responsibilities include:    

• Develop and maintain relationships with existing clients    
• Provide assistance to Midwest Regional Sales Manager in development of territory
• Provide assistance to V.P. of Sales
• Make calls on existing clients to copy and pick up referrals
• Attend conferences
• Enter daily activities through CRM platform
• Travel within assigned territory

Ideal candidate will possess one or more of the following:

• Three to five years of insurance and/or related insurance experience – Workers Compensation preferable
• Existing client base
• Self-Motivated and Goal Oriented

REQUIREMENTS

• College Degree
• Experience developing and maintaining a customer base
• Proven ability to positively impact sales
• Excellent communication, interpersonal, and influencing skills
• Strong Computer skills
• Excellent Time and Territory Management Skills
  

Nurse Review Analyst

The Nurse Review Analyst will complete comprehensive reviews and analysis of records, to assess 
future medical care cost needs, to complete development of Medicare Set Aside Allocations.

DUTIES AND RESPONSIBILITIES

• Assesses file documents independently, to determine sufficiency of, and issues related to, development of
  a Medicare Set Aside Allocation (MSA)
• Identifies documentation applicable to rated age determinations
• Completes quality medical summary narratives, and analysis of provided documentation for development
  of the MSA allocation
• Assesses, identifies and documents critical elements in consideration of MSA allowance reductions and
  treatment guidelines
• Finalizes the MSA allocation including cost projections
• Performs utilization of resource databases for diagnoses, treatment guidelines, and prescription
  medication pricing, and documents the MSA allocation when applicable
• Participates in scheduled meetings with other staff; operations, production, the legal department, and
  other individuals or groups
• Works with legal team in coordination of efforts

MINIMUM JOB REQUIREMENTS

Preferred minimum job requirements include:

• Registered Nursing license in good standing with the applicable Board of Nursing
• Three to five years experience related to the duties and responsibilities specified
• Education which may be substituted for required experience.
• Certification in any of the following, including but not limited to: Rehabilitation Counseling, Disability
  Management, Utilization Review, Life Care Planning, Medical Coding, Legal Nurse Consulting,
  and Medicare Set Aside Consultation.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

Preferred skills and abilities include:

• Strong interpersonal, oral, and written communication skills including report preparation preferred
• Ability to work effectively independently and as a member of a team
• Ability to gather data, compile and synthesize information, including medical information, claims payment
  histories and billing, to identify level and types of services utilization for completion of MSA allocations
• Knowledge, understanding and application of  Medicare and treatment guidelines, and reduction
  allowances in MSA allocation development
• Records maintenance skills in a computer database

This description is a general statement of required major duties and responsibilities performed on a regular 
and continuous basis
 
Narrative Writer

The Narrative Writer’s responsibility is to review and analyze medical records, in order to complete medical 
summaries for development of Medicare Set Aside Allocations as part of our blended medical and legal team 
approach.

RESPONSIBILITIES:

• Review file documents; referral forms, medical records, claims payment history, and billing.
• Assess, identify and document critical elements in consideration of MSA  
• Complete the medical summary per established processes and protocol utilizing appropriate formatting
• Document daily activity reports for review to verify status of daily tasks
• Process task assignments in accordance with established policies and procedures
• Document activities as required in the provided databases
• Participate in scheduled meetings with other staff; operations, production, the legal department, and other
  individuals or groups as directed
• Performs miscellaneous job-related duties as assigned.

EDUCATION:

• BS or BA degree in a medically related or allied health science i.e. Biology, Chemistry.
• Medical certifications a plus

EXPERIENCE AND REQUIRED SKILLS:

• 0-2 years business experience
• Must be a person who enjoys writing and has had experience doing business writing
• Certifications in any of the following, including but not limited to: Medical Terminology, Medical Coding,
  or Medicare Set Aside Consultation.
• Must have knowledge of medical terminology
• Strong interpersonal, oral, and written communication skills including report preparation
• Ability to work effectively independently and as a member of a team
• Knowledge of and ability to utilize computer databases and programs for research and report preparation
• Ability to gather data, compile and synthesize information, including medical information, claims payment
  histories and billing, to complete medical summaries subsequent completion of MSA allocations
• Record maintenance skills in a computer database   

Legal Assistant

CPSC is seeking a highly motivated individual to assist with the legal and medical case development and the 
administrative management of our Medicare Compliance Team which consists of lawyers and nurses.

RESPONSIBILITIES:

• Under direction, provide initial review and setup of  medical files
• Manage day to day correspondence with clients, medical professionals, attorney’s offices, and Federal
  agencies
• Work with attorney to determine case priority based on case type and available data
• Coordinate with offsite teams to track process of files
• Work with attorneys to generate creative solutions
• Handle material of a highly confidential nature as well as a variety of complex situations
• Managing workflow of cases within established guidelines
• Make independent decisions regarding planning, organizing & scheduling of work
• Responsible for confidential and time sensitive material
• Other duties as assigned

EDUCATION:

• Bachelor’s degree or Associates Degree and 6+ month’s business experience or HS Diploma with 2 years
  business experience.

EXPERIENCE:

• 2 years business experience without a degree, or 6 months with a degree
• Knowledge of business & medical vocabulary
• Ability to employ basic reasoning skills
• Knowledge of basic computer software such as MS office suite
• Ability to communicate (verbally & written) with considerable tact & diplomacy
• Capable of analyzing complex information & organizing in an appropriate manner
• Ability to exercise considerable discretion & independent judgment when making decisions and interacting
  with clients
• Proven ability to work in fast paced, detail oriented environment
• Prior experience in developing and submitting petitions to state or Federal administrative bodies is a plus,
  but not required