Submissions Planner

Do you want to contribute to a dynamic, values-oriented workplace? If so, you'll fit right in with the team at ExamWorks Compliance Solutions (ECS).

The Submissions Planner works autonomously to develop any and/or all of the following: Medicare Set-Aside Allocations,production of CMS submissions of Medicare Set Aside Allocations,Bill Reviews and other reports as needed within their scope of licensing and/or certifications.

This is a full-time 100% remote position, Monday-Friday, 8:30am - 5:00pm. Must have Medicare Set-aside Certified Consultant (MSCC).

ESSENTIAL JOB FUNCTIONS

• Collects, reviews and analyzes health data from medical records and/or other sources as provided.
• Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care.
• Work autonomously and collaborate with all company personnel as needed; including communicating with the accounts and attorneys as needed.
• Conducts research on Medicare expenses allowed in appropriate state for workers' compensation and keeps abreast of all changes in law and Centers for Medicare/Medicaid Services guidelines.
• Works with claim adjusters to obtain clarification on outstanding issues for MSA/CMS submission
• Works with claim adjusters and attorneys in negotiating and defending recommended allocations as necessary. Maintain a quality work product evidenced by acceptable quality scores/score cards.
• Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company.
• Attend all scheduled conference calls as mandated by management.
• Maintain any required credentials and adhere to all codes of ethics required by these credentials.
• Ensures all federal Centers for Medicare and Medicaid Services (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, URAC and CMS guidelines.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.

Education and/or Experience

Minimum of an Associates degree or equivalent certification preferred. A minimum of one years workers' compensation and/or case management experience preferred. A minimum of one year experience in Medicare Set Asides required.

Certificates, Licenses, Registrations

Will recognize any of the following: Active unrestricted Nursing license (including but not limited to RN, NP LVN, LPN). Active unrestricted Adjuster license. Certification in Medicare Set Asides and/or certifications in Life Care Planning or Legal Nurse Consulting.

QUALIFICATIONS

• Knowledge of the disability and workers' compensation industry including rules and regulations and a full understanding of Medicare rules and regulations.
• Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
• Must have adequate knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Ability to demonstrate critical thinking and problem solving skills.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Ability to concentrate and multitask in a fast paced work environment.
• 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 maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Must be able/willing to work on a flexible schedule when needs arise.
• Must possess excellent skills in English usage, grammar, punctuation and style.

ExamWorksis a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

ExamWorksoffers a fast-paced team atmosphere withcompetitive benefits, paid time off, and 401k.

ExamWorks, LLC is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

#LI-MB1