Medicare Set Aside Specialist I

The Medicare Set-Aside Consultant develops reports based upon guidelines provided by the Centers for Medicare and Medicaid Services outlining the future Medicare-covered expenses of individuals whose workers’ compensation or other liability claims are in the settlement process.

The Medicare Set-Aside Consultant will rely on their medical knowledge to evaluate the patient’s treatment plan for future medical treatment needs supporting the goals of the Medicare Services department, and of CorVel.

Work from home possible.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES :

• Organize medical records into chorological order.
• Assess, review and summarize medical records in a clear, concise manner.
• Perform evidenced based medical research regarding unfamiliar diagnoses and future medical needs.
• Ability to utilize medical and nursing knowledge to compile comprehensive list of necessary future Medicare-covered expenses.
• Assign CPT coding and pricing to all future Medicare-covered expenses.
• Assign NDC coding and AWP pricing to all future medication pricing.
• Clarify need for Rated Age and obtain or calculate life expectancy.
• Calculate lifetime pricing utilizing state fee schedule or usual & customary charges.
• Collaborate with defense and plaintiff counsel in effort to obtain necessary signed releases from claimants.
• Verify claimant’s current Social Security Disability and Medicare eligibility.
• Prepare submission of MSA proposal to CMS for review and approval.
• Secure, analyze and dispute Medicare conditional payments unrelated to claim / s in settlement process.
• Required to read extensively.
• Required to prepare organized reports within a specified timeframe.
• Required to use telephone extensively.
• Minimum Productivity Standard is 95%
• Requires regular and consistent attendance.
• Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
• Additional duties as required.

KNOWLEDGE & SKILLS :

• Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
• Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors / clients and coworkers.
• Excellent written and verbal communication skills.
• Ability to meet designated deadlines.
• Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
• Strong interpersonal, time management and organizational skills.
• Ability to work both independently and within a team environment.

EDUCATION & EXPERIENCE :

• Graduate of accredited school of nursing, BSN desirable.
• Current RN Licensure in state of operation.
• 3 or more years’ of recent clinical experience, preferably in rehabilitation.
• Certification as a MSCC, CLCP, or CNLCP preferred.
• ICHCC approved course in Medicare Set-Aside completion within 3 months of hire date required.
• Successfully pass ICHCC Medicare Set-Aside Consultant examination within 4 months of hire date.
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred.
• Strong cost containment background, such as utilization review or managed care helpful.

ABOUT CORVEL :

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.

CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients.

We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w / Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.