RN Medicare Compliance Senior
Posted on: May 13, 2022
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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)
**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
+ 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
+ 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
+ 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
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**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.
Six (6) years of related experience or equivalent combination of
education and experience required to include five (5) years of MSA
**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
When applicable and appropriate, consideration will be given to
**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
**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
Sedgwick is an Equal Opportunity Employer and a Drug-Free
Keywords: Sedgwick, Olympia , RN Medicare Compliance Senior, Healthcare , Olympia, Washington
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