MSA & MCP Specialist

ForzaCare•Tampa, FL

4d•Remote

About The Position

ForzaCare is seeking a full-time Medical Set-Aside & Medical Cost Projection Specialist to coordinate and support Medicare Secondary Payer (MSP) compliance services, including Medicare Set-Asides (MSAs), Conditional Payments, Life Care Plans, and Medical Cost Projections. The specialist manages cases from intake through completion, ensuring deliverables are accurate, comply with CMS guidelines, and support internal teams and external clients. The position is predominantly remote, with limited travel as needed. The role involves managing case workflows, processing referrals and documentation, tracking progress, supporting Medicare compliance and administration, organizing medical records, assisting with cost estimates, quality-checking deliverables, and communicating with clients and internal teams. Work requires prolonged stationary periods, continuous computer and standard office equipment use, and regular communication by phone, video, and written correspondence.

Requirements

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

Nice To Haves

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

Responsibilities

Manage case workflow from intake through completion, ensuring timelines and service standards are met.
Review and process new referrals and confirm 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 MSAs, 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.