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Medicare Compliance Nurse
at Sedgwick CMS in Georgia
Medicare Compliance Nurse - Work From Home
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE
To prepare and draft Medicare Set-Asides (MSAs), Medical Cost Projects (MCPs) and related products.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Prepares and drafts Medicare Set-Asides (MSAs), Medical Cost Projects (MCPs) and related products.
Reviews medical claims and legal records; provides concise written reports depicting past medical care, current medical status and anticipated future medical care in MS Word and Excel format; creates reports documenting comprehensive and detailed medical summaries, evaluation of past treatment procedures, and prediction and accurate pricing of future treatment plan(s).
Provides consulting services for assigned claims examiner and defense counsel related to Medicare and medical issues including, but not limited to, advising how to reduce an MSA, explanation of the MSA process, and discussion of specific medical procedures.
Provides required training to examiners handling medical/Medicare issues related to general liability and workers' compensation.
Creates and implements custom solutions to Medicare related problems including formulating solutions and communicating effectively verbally and in writing with healthcare providers, claims examiners and defense counsel to implement solutions.
Identifies and resolves issues related to pricing MSAs and MCPs.
Ensures quality, medical soundness, accuracy and timely delivery of MSA allocations and MCPs.
Provides changes/updates to the MSA document/process as indicated within Medicare guidelines and industry standards to provide clients with the best MSA project available.
Maintains appropriate file documentation.
Maintains comprehensive knowledge of pricing trends for MSAs; incorporates trends into MSA and MCP reports.
Maintains thorough knowledge of state laws to ensure proper compliance.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the total performance management initiative.
Travels as required.
QUALIFICATIONS
Education & Licensing
BS/BA degree or equivalent preferred.LVN or LPN and CPUR or equivalent certification required. Medicare Set-Aside Consultant Certified (MSCC) certification required.
Experience
Seven (7) years of related experience required to include two (2) years of MSA writing experience. AS/AA degree may substitute for one (1) year of experience; BS/BA degree may substitute for two (2) years experience; MS/MA degree may substitute for three (3) years experience.
Skills & Knowledge
Thorough knowledge of MSA creation and pricing
Proficiency in medical research online and in written text
Excellent oral and written communication skills
PC literate, including Microsoft Office products
Excellent mathematical skills
Analytical and interpretive skills
Strong organizational skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:Computer keyboarding, travel as required
Auditory/Visual:Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances.Management retains the discretion to add or to change the duties of the position at any time.
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
Sedgwick CMS is an Equal Opportunity Employer and a Drug-Free Workplace
Medicare Set-Aside Consultant Certified (MSCC) Certification Required to be considered for this position.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/15230765
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE
To prepare and draft Medicare Set-Asides (MSAs), Medical Cost Projects (MCPs) and related products.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Prepares and drafts Medicare Set-Asides (MSAs), Medical Cost Projects (MCPs) and related products.
Reviews medical claims and legal records; provides concise written reports depicting past medical care, current medical status and anticipated future medical care in MS Word and Excel format; creates reports documenting comprehensive and detailed medical summaries, evaluation of past treatment procedures, and prediction and accurate pricing of future treatment plan(s).
Provides consulting services for assigned claims examiner and defense counsel related to Medicare and medical issues including, but not limited to, advising how to reduce an MSA, explanation of the MSA process, and discussion of specific medical procedures.
Provides required training to examiners handling medical/Medicare issues related to general liability and workers' compensation.
Creates and implements custom solutions to Medicare related problems including formulating solutions and communicating effectively verbally and in writing with healthcare providers, claims examiners and defense counsel to implement solutions.
Identifies and resolves issues related to pricing MSAs and MCPs.
Ensures quality, medical soundness, accuracy and timely delivery of MSA allocations and MCPs.
Provides changes/updates to the MSA document/process as indicated within Medicare guidelines and industry standards to provide clients with the best MSA project available.
Maintains appropriate file documentation.
Maintains comprehensive knowledge of pricing trends for MSAs; incorporates trends into MSA and MCP reports.
Maintains thorough knowledge of state laws to ensure proper compliance.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the total performance management initiative.
Travels as required.
QUALIFICATIONS
Education & Licensing
BS/BA degree or equivalent preferred.LVN or LPN and CPUR or equivalent certification required. Medicare Set-Aside Consultant Certified (MSCC) certification required.
Experience
Seven (7) years of related experience required to include two (2) years of MSA writing experience. AS/AA degree may substitute for one (1) year of experience; BS/BA degree may substitute for two (2) years experience; MS/MA degree may substitute for three (3) years experience.
Skills & Knowledge
Thorough knowledge of MSA creation and pricing
Proficiency in medical research online and in written text
Excellent oral and written communication skills
PC literate, including Microsoft Office products
Excellent mathematical skills
Analytical and interpretive skills
Strong organizational skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:Computer keyboarding, travel as required
Auditory/Visual:Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances.Management retains the discretion to add or to change the duties of the position at any time.
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
Sedgwick CMS is an Equal Opportunity Employer and a Drug-Free Workplace
Medicare Set-Aside Consultant Certified (MSCC) Certification Required to be considered for this position.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/15230765
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Published on Feb 17, 2010
Viewed: 571 times
Viewed: 571 times
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