Medicare Set-Aside Analyst

EXAMWORKS COMPLIANCE SOLUTIONS LLC; Lawrenceville (GA); Remote; USD 60,000 - 85,000; Full time

Job summary

EXAMWORKS COMPLIANCE SOLUTIONS LLC seeks a Determinations Specialist to analyze CMS determination letters and advocate for accurate Medicare Set-Aside recommendations. You will leverage clinical knowledge, research skills, and strong communication to support compliant MSA outcomes for clients.

The role requires MSCC certification or strong CMS knowledge, experience in MSA production, and a commitment to HIPAA compliance. Excellent analytical and written communication skills are essential.

Qualifications

• MSCC certification preferred.
• Strong knowledge of WCMSA Reference Guide and CMS guidelines.
• 12+ months in an MSA production environment or related experience.
• Prior customer service experience required.
• Baseline HIPAA knowledge and compliance.

Responsibilities

• Evaluate CMS determination letters for accuracy.
• Identify discrepancies and conduct targeted research.
• Advocate for accurate Medicare Set-Aside recommendations.
• Collaborate with clients to ensure compliant MSA outcomes.
• Maintain confidentiality and manage time efficiently.

Skills

Analytical skills

Research

Problem solving

Written communication

Verbal communication

Attention to detail

Time management

Discretion/confidentiality

Education

High school diploma or equivalent

Associate’s degree preferred

Tools

Microsoft Word

Outlook

Excel

Adobe

Internet

Job description

EXAMWORKS COMPLIANCE SOLUTIONS LLC seeks a Determinations Specialist to analyze CMS determination letters and advocate for accurate Medicare Set-Aside recommendations. You will leverage clinical knowledge, research skills, and strong communication to support compliant MSA outcomes for clients.

The role requires MSCC certification or strong CMS knowledge, experience in MSA production, and a commitment to HIPAA compliance. Excellent analytical and written communication skills are essential.