REMOTE Determinations Specialist

Fully Remote • Lawrenceville, GA 30043

• Salary Range: $50,000.00 - $55,000.00 Salary
• Position Type: Full Time

Are you a Medicare Set-Aside expert who enjoys analyzing complex cases, solving problems, and making a meaningful impact? ECS is seeking a highly skilled Determinations Specialist to join our team and play a critical role in advocating for accurate Medicare Set-Aside (MSA) recommendations and ensuring compliance with CMS guidelines.

In this position, you'll leverage your clinical knowledge, analytical expertise, and critical thinking skills to evaluate CMS determination letters, identify discrepancies, conduct research, and support successful MSA outcomes for our clients. If you're passionate about navigating complex regulatory requirements and collaborating with clients to achieve the best possible results, we'd love to hear from you.

Schedule: Monday-Friday, 8:00 AM-5:00 PM

Required Qualifications

• MSCC (Medicare Set-Aside Certified Consultant) certification is preferred.
• Strong knowledge of the WCMSA Reference Guide and CMS Medicare coverage guidelines is preferred.
• Exceptional analytical, research, and problem-solving skills
• Strong written and verbal communication abilities

Medicare Set-aside Certified Consultant (MSCC)
Medicare Set-aside (MSA)
Centers for Medicare & Medicaid Services (CMS)
Workers' Compensation Review Contractor (WCRC)
MSP Compliance
Medicare Secondary Payer (MSP)

Qualifications

Education and/or Experience

High school diploma or equivalent required. Associate’s degree preferred. Prior customer service experience required. A minimum of twelve months MSA production environment experience or related experience is preferred.

QUALIFICATIONS

• Previous Customer Service experience required. Minimum 12 months production environment experience or related experience preferred.
• Adequate knowledge of 3rd party/COB (Coordination of Benefits) / insurance verification / medical billing (ICD-9/CPT) experience preferred.

• Competency in mathematics, business terminology, clerical skills and time management.

• Must possess complete knowledge of general computers, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, Adobe and the Internet.
• Must have a full understanding of HIPAA regulations and compliance.
• Ability to follow instructions and respond to 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 demonstrate strong written and oral 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.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team-oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Demonstrates reliability and abides by the company attendance policy.
• Must maintain a professional and clean appearance at all times consistent with company standards.