Teams at ExamWorks Compliance Solutions

Analyze medical records and forecast future healthcare needs to prepare compliant Medicare Set-Aside allocations. Review reports against CMS, state, and URAC requirements; collaborate with attorneys, account teams, and management; communicate regulatory findings; maintain quality standards; and manage independent, confidential work in a remote environment.

Investigates Medicare conditional payment referrals, obtains documentation, tracks claims with Medicare contractors, triages correspondence, updates systems and clients, verifies Medicare eligibility, and supports Medicare Advantage, Medicaid, and Treasury-related services while maintaining compliance, confidentiality, accuracy, and timely communication.

Remote role managing Medicare conditional payment referrals: investigate referrals, follow up with Medicare contractors, perform eligibility/verifications, document case notes, communicate with clients and management, and ensure compliance with contractual and regulatory standards.