RN - Medical Allocator I

$50,593 - $81,593/Yr

CorVel - West Des Moines, IA

Full-time - Mid Level

Remote - West Des Moines, IA

Insurance Carriers and Related Activities

About the position

The Medicare Set-Aside Consultant develops reports based upon guidelines provided by the Centers for Medicare and Medicaid Services outlining the future Medicare-covered expenses of individuals whose workers' compensation or other liability claims are in the settlement process. The Medicare Set-Aside Consultant will rely on their medical knowledge to evaluate the patient's treatment plan for future medical treatment needs supporting the goals of the Medicare Services department, and of CorVel. Work from home possible.

Responsibilities

• Organize medical records into chronological order.
• Assess, review and summarize medical records in a clear, concise manner.
• Perform evidenced based medical research regarding unfamiliar diagnoses and future medical needs.
• Utilize medical and nursing knowledge to compile comprehensive list of necessary future Medicare-covered expenses.
• Assign CPT coding and pricing to all future Medicare-covered expenses.
• Assign NDC coding and AWP pricing to all future medication pricing.
• Clarify need for Rated Age and obtain or calculate life expectancy.
• Calculate lifetime pricing utilizing state fee schedule or 'usual & customary' charges.
• Collaborate with defense and plaintiff counsel in effort to obtain necessary signed releases from claimants.
• Verify claimant's current Social Security Disability and Medicare eligibility.
• Prepare submission of MSA proposal to CMS for review and approval.
• Secure, analyze and dispute Medicare conditional payments unrelated to claim/s in settlement process.
• Read extensively.
• Prepare organized reports within a specified timeframe.
• Use telephone extensively.
• Meet Minimum Productivity Standard of 95%.
• Maintain regular and consistent attendance.
• Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
• Perform additional duties as required.

Requirements

• Graduate of accredited school of nursing, BSN desirable.
• Current RN Licensure in state of operation.
• 3 or more years' of recent clinical experience, preferably in rehabilitation.
• Certification as a MSCC, CLCP, or CNLCP preferred.
• ICHCC approved course in Medicare Set-Aside completion within 3 months of hire date required.
• Successfully pass ICHCC Medicare Set-Aside Consultant examination within 4 months of hire date.
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred.
• Strong cost containment background, such as utilization review or managed care helpful.

Nice-to-haves

• Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
• Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers.
• Excellent written and verbal communication skills.
• Ability to meet designated deadlines.
• Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
• Strong interpersonal, time management and organizational skills.
• Ability to work both independently and within a team environment.

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off