Submissions Specialist (32906)

• 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.

Qualifications

• High school diploma or equivalent required.
• Minimum of one year experience in an administrative role withMedicare Secondary Payer experience.
• Minimum of one year experience in one of the following fields required:Medical,Pharmaceutical, orInsurance.
• Medicare Set-aside Certified Consultant (MSCC) certification preferred, but not required.
• Must have strong knowledge ofmedical terminology, medications and laboratory values.
• Knowledge of currentMedicare 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.