[Hiring] Determinations Specialist @IME RESOURCES LLC

Role Description

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
• 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

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.
• 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.
• Previous Customer Service experience required.
• 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 management’s directions accurately.
• Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality.
• Must demonstrate strong written and oral communication skills.
• 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.

Company Description