Submissions Specialist (32906)

EXAMWORKS COMPLIANCE SOLUTIONS LLC•Lawrenceville, GA

13d•$20 - $22•Remote

About The Position

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.

Requirements

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.
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.

Nice To Haves

Medicare Set-aside Certified Consultant (MSCC) certification preferred, but not required.

Responsibilities

Responsible for the Medicare Set-aside Allocations for submission to the Centers for Medicare and Medicaid Services (CMS).
Ensure 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.
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.