The Role
Reviews Medicare Set-aside reports, claimant Medicare status, medical records, payment and prescription histories, and legal documents to prepare CMS submissions. Communicates case status and information needs to adjusters, attorneys, and account executives; revises submissions after quality review; maintains caseload diaries; runs reports; and ensures compliance with CMS requirements, state mandates, and client agreements.
Summary Generated by Built In
ECS is seeking a professional experienced in Medicare for our *Remote* Submissions Specialist role.
The Submissions Specialist is responsible for the Medicare Set-aside Allocations for submission to the Centers for Medicare and Medicaid Services (CMS). This position has a complete understanding of the submission process, requirements and guidelines set in place by CMS and ensures work is processed and completed with the highest level and integrity and in full compliance with client contractual agreements, regulatory agency standards and/or any required federal and state mandates.
This role is between the hours of Monday-Friday 8-5pm.
- Review the MSA Report, Claimant's Medicare status, CMS requirements and obtain all necessary information for a successful submission with CMS, including development letters issued by CMS.
- Effectively communicate both verbally and through written response the needs and status of a case with the assigned claims adjuster, attorneys and/or account executive.
- Review medical records in conjunction with the associated payment and/or prescription history and legal documents to fully understand a case and recognize any missing elements.
- As needed and in preparation for final CMS submission, revise submissions after quality control review and recommendations are received.
- Independently and punctually maintain the diaries of all assigned caseload.
- Run reports, as needed, for their own job duties as well as at the request of their assigned Account Executives.
- Maintain an in-depth knowledge of the current requirements and guidelines issued by CMS.
- Ensures all federal CMS requirements and/or state mandates are adhered to at all times.
- Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications and CMS guidelines.
- High school diploma or equivalent required.
- Minimum of one year experience in an administrative role with Medicare Secondary Payer experience.
- Minimum of one year experience in one of the following fields required: Medical, Pharmaceutical, or Insurance.
- Medicare Set-aside Certified Consultant (MSCC) certification preferred, but not required.
- Must have strong knowledge of medical terminology, medications and laboratory values.
- Knowledge of current Medicare Secondary Payer statues.
- Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
- Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
- Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
Who We Are:
ECS was formed in 2014 from the acquisition and consolidation of two pillars within the Medicare Secondary Payer (MSP) compliance industry: Gould & Lamb, providers of MSP compliance and reporting services, and MedAllocators/Ability Services Network, a national provider of MSP compliance and case management. Launched as Examworks Clinical Solutions, the new company offered unprecedented, integrated services aimed at managing high dollar complex Medicare, medical, and pharmaceutical claims. In May 2020, the organization name was changed to ExamWorks Compliance Solutions. A single word change, but one that truly reflects the core of what is offered by ECS. Today, our mission remains focused on providing the most comprehensive, creative, and customizable compliance and
reporting solutions for the marketplace.
reporting solutions for the marketplace.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
ExamWorks Compliance Solutions offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
Skills Required
- High school diploma or equivalent
- At least one year of administrative experience with Medicare Secondary Payer experience
- At least one year of experience in medical, pharmaceutical, or insurance work
- Strong knowledge of medical terminology, medications, and laboratory values
- Knowledge of current Medicare Secondary Payer statutes
- Ability to perform arithmetic calculations using whole numbers and decimals and compute rates and percentages
- Strong knowledge of Microsoft Word, Outlook, Excel, and internet software
- Exceptional written and verbal communication skills
- Medicare Set-aside Certified Consultant certification
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The Company
What We Do
ExamWorks Compliance Solutions is a leading authority on Medicare compliance and mandatory insurer reporting. The company provides comprehensive, customizable reporting and compliance solutions, including Medicare Set-Asides (MSAs), conditional payment services, and outcome management. Leveraging clinical and legal expertise, it serves property and casualty insurance carriers, law firms, and government agencies to manage complex medical and pharmaceutical claims.
