MSA & MCP Specialist

ForzaCare•Tampa, FL

2d•Remote

About The Position

ForzaCare is seeking a full-time Medical Set-Aside & Medical Cost Projection Specialist to coordinate and support Medicare Secondary Payer compliance services, including Medicare Set-Asides, Conditional Payments, Life Care Plans, and Medical Cost Projections. The specialist manages cases from intake through completion, ensuring deliverables are accurate, compliant with CMS guidelines, and useful to internal teams and external clients. The position is predominantly remote, with limited travel as needed.

Requirements

Active Registered Nurse license, or Certified Rehabilitation Counselor (CRC) license with an associated college degree, or CCM certification.
Valid driver's license, reliable transportation, and auto insurance.
Experience in Medicare compliance, submissions, and appeals.
Basic knowledge of medical terminology, diagnoses, and procedures.

Nice To Haves

Certified Medicare Secondary Payer (CMSP) certification is strongly preferred.
Other preferred certifications include MSCC, MSA-C, CLCP, CNLP, or CDMS.
Background in workers' compensation, medical case management, or cost containment.

Responsibilities

Manage case workflows from intake through completion and ensure timelines and service standards are met.
Review and process new referrals, confirming that required documentation is obtained.
Track case progress, monitor pending items, and follow up to ensure timely resolution.
Maintain accurate internal logs, tracking systems, and status updates.
Ensure work aligns with CMS guidelines and Medicare Secondary Payer regulations.
Use CMS systems, including WCMSA and MSPRP, to support case processing and submissions.
Review and respond to CMS correspondence, including approvals and development requests.
Assist with Medicare entitlement verification, including coordination with the BCRC.
Review and organize medical records to assess treatment history and future care needs.
Support preparation of Medicare Set-Asides, Conditional Payment investigations, and cost projections.
Assist in estimating future medical costs based on documentation and established guidelines.
Ensure deliverables meet compliance standards and are defensible.
Perform quality checks on reports, submissions, and supporting documentation.
Ensure accuracy, consistency, and completeness across case deliverables.
Communicate with clients about case status, documentation needs, and timelines.
Collaborate with internal operations teams and clinical resources.