Job Description
Position Overview
We are looking for compassionate and detail-oriented Medical Analysts with experience in preparing Medicare Set-Asides and Medical Cost Projections. In this role, you will review medical records, craft narratives, and allocate costs for medical treatment and prescription medications. Candidates should have a strong understanding of CMS policies regarding MSAs and be adept in writing, analysis, and applying guidelines. You'll collaborate closely with our attorneys and medical team to provide essential support in developing Medicare Set-Asides and Medical Cost Projections.
Day-to-Day Responsibilities
Review relevant medical files and documentation to provide a comprehensive narrative and cost projection for future treatment related to Workers' Compensation and Liability injuries, ensuring compliance with current guidelines.
Collaborate with a dedicated team of attorneys and medical professionals to identify, negotiate, and document guidelines and potential cost reductions for future treatment plans.
Utilize proprietary technology tools to assess diagnoses, treatment guidelines, and prescription pricing, documenting findings as necessary.
Offer additional analysis and medical recommendations as needed to enhance the care provided.
Identify cost drivers and opportunities for savings across all cases, and engage in client-specific cost mitigation activities where applicable.
This is a full-time position with potential for additional hours during peak times.
Occasional travel (less than 10% of the time) may be required.
Qualifications
Who You Are
Bachelor's Degree, Associate Degree, or Diploma in Nursing is required.
3-5 years of experience in Nursing is preferred.
A valid Registered Nurse (RN) license in good standing with the applicable Board of Nursing is required.
Experience in preparing medical review reports, medical bill reviews, and utilization reviews in injury cases is a plus.
Certifications such as Medicare Set-Aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), Medical Coding, Legal Nurse Consulting, Rehabilitation Counseling, Disability Management, or Utilization Review are preferred.
Strong interpersonal, oral, and written communication skills, including proficiency in report preparation.
Ability to work independently and collaboratively as part of a team.
Proficient in gathering data and synthesizing medical information, claims payment histories, and billing to identify levels and types of service utilization.
Why Join Us?
For over 50 years, we have been a leader in data analytics and technology within the global insurance industry, providing exceptional value through our expertise and scale. We offer you the opportunity to voice your ideas and build a rewarding career that reflects your unique skills, along with flexible work options, support, coaching, and training to help you thrive.
We pride ourselves on our outstanding workplace culture, recognized for the eighth consecutive year as a Great Place to Work® in the U.S., and celebrated in several countries for our commitment to inclusivity and diversity. Join a vibrant community of 7,000 individuals dedicated to ethical innovation and the power of big data to create a brighter future.
Employment Type: Full-Time
Salary: $ 34.00 Per Hour
Job Tags
Hourly pay, Full time, Flexible hours,