Submissions Specialist
The Submissions Specialist is responsible for the Medicare Set-Aside Allocations for submission to the Centers for Medicare and Medicaid Services (CMS). This position has a complete understanding of the submission process, requirements and guidelines set in place by CMS. Ensure work is processed and completed with the highest level and integrity and in full compliance with client contractual agreements, regulatory agency standards and/or any required federal and state mandates.
Education and/or Experience
High School Diploma or equivalent required. Minimum of one year experience in one of the following fields required:
• Medical or Pharmaceutical
• Insurance
• Medicare Secondary Payer
Certificates, Licenses, Registrations
MSCC Certification preferred
ESSENTIAL JOB FUNCTIONS
• 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 and/or special circumstances which could present issues through the CMS submission process.
• 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.
• Create, and modify queries within the operating system to assist with own job functions.
• 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.
• Ensure 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.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
QUALIFICATIONS
• Minimum of one year experience in an administrative role with Medicare Secondary Payer within the Submission department.
• Must have strong knowledge of medical terminology, medications and laboratory values.
• Knowledge of current Medicare Secondary Payer statutes
• 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 be able to operate a general computer, fax, copier, scanner, and telephone.
• Knowledge of Galileo Enterprise useful.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Suite, Outlook and the Internet.
• Must have excellent skills in English usage, grammar, punctuation and style.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Ability to follow instructions and respond to upper managements’ directions accurately.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must be able to multi-task, prioritize work activities and use time efficiently.
ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
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Education and/or Experience
High School Diploma or equivalent required. Minimum of one year experience in one of the following fields required:
• Medical or Pharmaceutical
• Insurance
• Medicare Secondary Payer
Certificates, Licenses, Registrations
MSCC Certification preferred
ESSENTIAL JOB FUNCTIONS
• 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 and/or special circumstances which could present issues through the CMS submission process.
• 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.
• Create, and modify queries within the operating system to assist with own job functions.
• 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.
• Ensure 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.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
QUALIFICATIONS
• Minimum of one year experience in an administrative role with Medicare Secondary Payer within the Submission department.
• Must have strong knowledge of medical terminology, medications and laboratory values.
• Knowledge of current Medicare Secondary Payer statutes
• 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 be able to operate a general computer, fax, copier, scanner, and telephone.
• Knowledge of Galileo Enterprise useful.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Suite, Outlook and the Internet.
• Must have excellent skills in English usage, grammar, punctuation and style.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Ability to follow instructions and respond to upper managements’ directions accurately.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must be able to multi-task, prioritize work activities and use time efficiently.
ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Apply tot his job
Apply To this Job