Medicare Set-aside Analyst

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.

Summary

Prepares future medical cost projections and Medicare Set-aside Allocation reports. Interacts regularly with customers providing excellent customer service. Communicates daily with internal teams at IMPAXX.

Essential Duties And Functions

• Reviews and analyzes medical records, claim file documents, hearing orders, and depositions for preparation of allocation reports.
• Researches Medicare coverage, jurisdictional, and regulatory guidelines.
• Communicates frequently and effectively with Team Leader, Coding Team, Clinical Director, and Referral Coordinators.
• Reviews resources on the Analyst iPortal and IMPAXX Intranet frequently, including customer handling instructions.
• Ensures thorough and accurate file documentation including data entered into MyConnect.
• Prepares future medical cost projections and Medicare Set-aside Allocation reports.
• Responsible for data entry into the medical tab for development of allocation preparation.
• Communicates with customer as needed for clarification of outstanding information needed to complete the allocation report requested.
• Provides rationale for allocation and identify mitigation opportunities.
• Reviews auto-MyConnect pricing function to ensure accuracy.
• Proofreads both calculation and summary generated.
• Provides feedback for possible improvements to workflow processes within the MyConnect system.
• Delivery of allocation report to customer identifying exposure and mitigation opportunities.
• Responds to direct inquiries from customer regarding delivered allocations or other MSP compliance questions from customer or facilitate the direction to the appropriate team.
• Reviews, analyzes, and communicates CMS counter opinions as assigned.
• Produce a minimum of 1.2 allocation reports per day based on a fiscal month end average.
• Maintains confidentiality and security of all medical records received and reviewed
• Any other duties as may be assigned.
  
  

Qualifications/ Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Required Qualifications

• 3-5 years of experience with Workers’ Compensation or Liability claims
• Proficiency with MS Office Suite
• Accurate typing skills and proficiency
• Excellent telephone demeanor
• Ability to work additional hours or a flexible schedule based on occasional increased work demands
• One of the following (multiple areas preferred):
• Bachelor Degree (preferred)
• Juris Doctorate (JD)
• Bachelor Degree Nursing, Registered Nurse (RN) License with 3-5 years clinical nursing experience
• Paralegal Certificate
• Claims management experience – three to five years
• MSA Analyst experience
  
  

Teammate Benefits & Total Well-Being

We go beyond standard benefits, focusing on the total well-being of our teammates, including:

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
• Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
• Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.
  
  

Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations.

The Power To Be Yourself

As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.