Medicare Set Aside (MSA) Specialist - Part-Time - REMOTE (KY)

Description

Reporting to the President, the Medicare Set-Aside (MSA) Specialist is responsible for evaluating, preparing, and submitting Medicare Set-Aside allocations in compliance with CMS guidelines and applicable state and federal regulations. This role ensures the protection of Medicare’s interests in workers’ compensation and liability settlements, collaborating with internal teams, clients, legal counsel, and medical professionals to deliver compliant, timely, and accurate MSA reports.

Position Specifics: Non-Exempt position working Part-Time Monday through Friday, in office or remotely.

Key Responsibilities

• Review and edit initial medical abstraction and MSA future medical allocation to ensure the MSA allocation meets both quality standards and client expectations. Includes review of medical records, billing statements, case notes, and pharmacy histories to develop accurate MSA allocation.
• Analyze and apply CMS guidelines, statutes, and state regulations related to Medicare Secondary Payer compliance.
• Support CMS Submission Specialists to ensure MSA packages are prepared accurately for submission to CMS. Requires detailed understanding of all CMS submission requirements, including workload thresholds and settlement details.
• Communicate with claims professionals, legal teams, and clients to gather necessary data for both case completion and case resolution
• Stay current on CMS policy changes and industry trends to ensure ongoing compliance and best practices.
• Respond to client inquiries and provide expert guidance on MSA processes, pricing, and submission requirements.
• Coordinate conditional payment searches, lien resolution, and related Medicare compliance services as needed.
• Maintain accurate documentation and records in accordance with organizational and regulatory requirements.
  
  

Benefits

• Base hourly rate
• Medical, Dental, Vision Insurance
• 401K
• Paid Time Off
• Paid Holidays
• Equipment provided
• Monthly internet stipend
  
  

Requirements

Required:

• 2+ years of experience in workers’ compensation, liability claims, medical case management, or Medicare compliance.
• Strong knowledge of Medicare Secondary Payer Act and CMS MSA guidelines.
• Proficiency in medical terminology and interpreting medical records.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines.
  
  

Preferred

• Certified Medicare Set-Aside Consultant (CMSP, MSCC, or equivalent certification).
• Experience with CMS submission processes and conditional payment resolutions.
• Background in nursing, medical coding, or legal support is a plus.
  
  

Work Environment

• Remote or office-based, depending on company policy.
• Standard office hours with occasional client or team meetings across time zones.
• Must maintain confidentiality and comply with HIPAA and data security protocols.
  
  

Physical Requirements

The candidate must be able to sit most of an 8-hour day, except for lunch and break times, and keyboard the majority of an 8-hour day, except for lunch and break times. The candidate must have manual dexterity. The candidate must be able to speak on the telephone intermittently throughout the day. The candidate must be able to read and write English fluently. The candidate must be able to provide and confirm a safe home office environment. The home office must be HIPAA compliant.

• Requires DSL, fiber, or cable internet connection from home, 100 Mbps preferred or better *