[Hiring] Medicare Set-Aside Specialist @Sanderson Firm

Role Description

The Medicare Set-Aside (MSA) Specialist is responsible for developing future medical allocation reports based on evidence-based medical guidelines and guidance published by the Centers for Medicare & Medicaid Services (CMS). In this role, the specialist will apply clinical expertise and professional judgment to prepare Medical Cost Projections and Medicare Set-Asides for workers’ compensation and liability settlements in accordance with established standards of practice.

The ideal candidate has strong analytical skills, clinical knowledge, and experience interpreting medical records to support accurate and compliant MSA allocations. Experience with Evidence-Based Medicare Set-Asides (EBMSAs) is strongly preferred.

Key Responsibilities

• Reviews and analyzes medical records, billing and payment documentation, and pharmacy histories to identify an injured individual’s past, current, and future treatment needs related to an accident or injury.
• Prepares clear and concise medical record summary narratives that outline findings and recommendations.
• Applies evidence-based medical treatment guidelines, including CMS guidelines, when developing future care recommendations.
• Documents and supports the rationale for findings and overall case analysis.
• Identifies and differentiates between Medicare-covered and non-Medicare-covered treatments.
• Assigns and incorporates appropriate CPT, HCPCS, and ICD codes based on case specifics.
• Communicates and collaborates with claims professionals, attorneys, physicians and their representatives, clients, and internal team members.
• Maintains company quality standards and adheres to documentation requirements.
• Meets weekly productivity goals while ensuring accuracy and regulatory compliance.

Qualifications

• Proficient in Microsoft Office Suite, including Word and Excel, for document preparation and data management.
• Effectively multitasks in a high-volume environment while maintaining accuracy and attention to detail.
• Demonstrates excellent written and verbal communication skills, with the capability to present information clearly and professionally.
• Meets designated deadlines in a fast-paced, production-driven environment.
• Brings strong interpersonal, organizational, and time management skills.
• Works both independently and collaboratively within a team environment.
• Maintains a high level of attention to detail and a strong commitment to quality.

Requirements

• Minimum of five (5) years of experience in Medicare Set-Aside (MSA) preparation and review.
• Graduate of an accredited school of nursing (BSN or LPN), or active Registered Nurse (RN) license required.
• Professional certification preferred, including MSACP, MSCC, CMSP, CLCP, or CNLCP.
• Minimum of five (5) years of experience in case management, utilization review, or claims management.

Benefits

• 100% Employer-Paid Medical Insurance for employees
• Dental & Vision Coverage
• 401(k) with Company Match
• Company-Paid Life Insurance
• Optional Short Term Disability, Accident Insurance and more
• Paid Time Off & Holidays
• Supportive and team-oriented culture