CMS Compliance & Workers' Comp Claims Specialist

Jobtailor; Maine; On-site; USD 60,000 - 90,000; Full time

Job summary

Jobtailor is seeking a detail-oriented CMS Compliance Specialist to manage Section 111 reporting for workers’ compensation claims. You will input CMS data and coordinate with claim representatives to resolve data issues while maintaining thorough documentation.

The role requires strong medical terminology knowledge, three years in workers’ compensation, and proficiency with WCXP/Compliance software and Microsoft Office. A degree or equivalent experience is required.

Qualifications

• Bachelor’s degree or eight years of relevant experience in lieu of a degree.
• At least three years of experience in workers’ compensation claims.
• Strong working knowledge of medical terminology, procedures and treatments.
• Extensive knowledge of workers’ compensation processes and state laws.
• Working knowledge of CMS reporting requirements preferred.
• Proficiency in Microsoft Office (Word and Excel).
• Ability to learn new software applications.
• Excellent organization and time management skills.
• Ability to handle multiple priorities and meet deadlines.
• Ability to communicate effectively, both verbally and in writing, and maintain confidentiality.

Responsibilities

• Ensure company compliance with CMS Section 111 reporting requirements.
• Manage CMS data elements for workers’ compensation claims.
• Verify data points and handle CMS inquiries, including notices and Medicare liens.
• Input Section 111 data into WCXP/Compliance fields for quarterly submissions.
• Maintain ORM diagnoses and TPOC/settlement details for Medicare-eligible workers.
• Update CMS compliance data for ORM termination within statutes of limitations.
• Establish and maintain diary tasks to monitor ORM reporting and termination.
• Maintain knowledge of termination rules across jurisdictions.
• Coordinate and resolve data issues with claim representatives.
• Document Section 111 activity in claim notes.
• Monitor CMS correspondence and Medicare Beneficiary inquiries.
• Direct payments as appropriate.
• Attend business unit, department, and company meetings.
• Assist with company projects and industry conferences.

Skills

CMS Compliance

Workers' Comp Claims

Medical Terminology

Data Management

Microsoft Office

Attention to Detail

Communication

Software Learning

Education

Bachelor’s degree or equivalent experience

Tools

WCXP/Compliance Software

Microsoft Word

Microsoft Excel

Job description

Jobtailor is seeking a detail-oriented CMS Compliance Specialist to manage Section 111 reporting for workers’ compensation claims. You will input CMS data and coordinate with claim representatives to resolve data issues while maintaining thorough documentation.

The role requires strong medical terminology knowledge, three years in workers’ compensation, and proficiency with WCXP/Compliance software and Microsoft Office. A degree or equivalent experience is required.