RN Medicare Compliance Senior

Company: Sedgwick
Location: Olympia
Posted on: May 13, 2022

Job Description:

**The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.**

RN Medicare Compliance Senior

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets-their employees, their customers and their property. At Sedgwick, caring counts -. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

Take advantage of working 100% remote from home!

**PRIMARY PURPOSE** **:** To provide professional assessment, planning, coordination, implementation and reporting of complex clinical data; to complete complex Submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare & Medicaid Services (CMS) guidelines.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Prepares and drafts complex Medicare Set-Asides (MSAs), Medical Cost Projects (MCPs), Submission cases, and related products; completes MCPs in preparation for reserve setting or settlement.

+ Performs comprehensive medical record reviews and evaluates Workers' Compensation Medicare Set-Aside proposals to make recommendation to Centers for Medicare & Medicaid Services (CMS) for final determination based on applicable coverage policies, coding guide lines and utilization and practice guidelines.

+ Reviews medical claims and completes complex file review for Medicare Set- Asides (MSA) and future medical cost projections.

+ Serves as a consultant to Medicare Compliance Nurses on claims.

+ Applies clinical knowledge and expertise with established clinical guidelines and provide clients with accurate and timely reviews of clinical referrals and a comprehensive analysis of medical treatment.

+ Assists with providing required training to examiners handling medical/Medicare issues related to general liability and workers' compensation and mentors less experienced colleagues.

+ Executes clear, concise and thorough medical record summary narratives for the purpose of inclusion in a Medicare Set-Aside or Future Medical Cost Projection.

+ Assesses, identifies and documents critical elements potentially impacting MSA cost projections for possible reduction and impact of any treatment guidelines and offers input to resolve issues.

+ Records and completes documentation of the findings and analysis of medical records.

+ Utilizes claims, legal, and/or nursing knowledge to analyze medical records and identify future medical treatment as documented in the medical records.

+ Utilizes resource data bases for diagnoses, treatment guidelines, and prescription medication pricing, documenting the MSA allocation when applicable and finalizes the MSA allocation including cost projections.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

+ Travels as required.

**QUALIFICATIONS**

**Education & Licensing**

RN licensure required. Medicare Set-Aside Consultant Certified (MSCC) certification required. Bachelor's degree or equivalent from an accredited college or university preferred.

**Experience**

Six (6) years of related experience or equivalent combination of education and experience required to include five (5) years of MSA writing experience.

**Skills & Knowledge**

+ Thorough knowledge of MSA creation and pricing

+ Proficiency in medical research online and in written text

+ Excellent oral and written communication skills

+ PC literate, including Microsoft Office products

+ Excellent mathematical skills

+ Analytical and interpretive skills

+ Strong organizational skills

+ Ability to work in a team environment

+ Ability to meet or exceed Performance Competencies

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical** **:** Computer keyboarding, travel as required

**Auditory/Visual** **:** Hearing, vision and talking

**NOTE** **:** Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

+ _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in (Colorado or New York City). Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the state noted in this job posting only, the range of starting pay for this role is_ 54,838.00 - 76,875.00 . A _comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Keywords: Sedgwick, Olympia , RN Medicare Compliance Senior, Healthcare , Olympia, Washington