Provides administrative and analytical support to a clinical team responsible for reviewing Medicare-related cases. The role focuses on preparing files for clinical review, organizing medical documentation, reviewing case materials, pricing future care services, and coordinating workflow in a remote, task-driven environment.
The position requires the ability to learn Medicare Set-Aside processes, manage a high volume of detailed assignments, meet production deadlines, and communicate clearly with clients and internal team members.
Key responsibilities:
- Conduct preliminary case reviews before files are assigned to Nurse Allocators.
- Review medical records, payment histories, pharmacy records, and related documents to confirm all materials needed for allocation development have been received.
- Identify missing information or documentation and contact clients to obtain clarification before case completion.
- Extract, organize, and categorize medical records received through client systems.
- Prepare and maintain allocation templates and supporting case documentation.
- Prioritize and coordinate workflow by assigning cases to Nurse Allocators and monitoring task progress.
- Price future care recommendations included in allocations using established pricing resources and systems.
- Assist with the preparation of treating physician statements provided to clients after allocations are completed.
- Support allocation reports by reviewing and summarizing medical records, billing records, and medical and pharmacy payment histories.
- Outline an injured individual's past, current, and anticipated future treatment needs related to the injury.
- Review and extract medical records needed for rated age submissions.
- Prepare documentation requests to obtain information required for rated age submissions.
- Provide additional administrative, analytical, and case support to the Clinical Support Supervisor as needed.
Requirements & Qualifications
Qualifications:
- Previous experience in the medical field is preferred.
- One to three years of experience in the insurance industry is preferred.
- Five or more years of Medicare Secondary Payer clinical experience is preferred.
- Professional certification such as MSCC, CMSP, CLCP, or CNLCP is preferred.
- Proficiency with Microsoft Office, including Word and Excel for document preparation and data management.
- Ability to manage multiple assignments in a high-volume environment while maintaining accuracy and attention to detail.
- Strong written and verbal communication skills with the ability to present information clearly.
- Ability to meet established deadlines in a fast-paced, production-driven environment.
- Strong interpersonal, organizational, and time-management skills.
- Ability to work independently in a remote setting and collaborate effectively with a team.
- Strong analytical skills and the ability to review detailed medical, billing, pharmacy, and case documentation.
- Consistent attention to detail and a commitment to high-quality work.
- Ability to learn and understand Medicare Set-Aside processes.
Benefits & Perks
Benefits and perks
- 100% employer-paid medical insurance for employees
- Dental and vision coverage
- 401(k) retirement plan with employer matching contributions
- Employer-paid life insurance
- Optional short-term disability coverage
- Optional accident insurance and additional voluntary benefits
- Paid time off
- Paid holidays
- Supportive and team-oriented work environment
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 weeks ago
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