MSA Specialist

About the role

About Our Client: The organization operates within the Medicare Secondary Payer (MSP) compliance services sector, addressing the complex regulatory requirements faced by insurance carriers, self-insured companies, third-party administrators, and governmental entities across the United States. By leveraging a team with extensive legal and clinical expertise, the company provides solutions to help clients achieve MSP-compliant settlements and maintains a strong client retention record. It has been recognized for its growth and innovation within the MSP industry.

About the Opportunity: The MSA SPECIALIST role focuses on developing future medical allocation reports using evidence-based guidelines to support compliant Medicare Set-Aside arrangements for workers’ compensation and liability settlements. This position plays a critical role in applying clinical expertise and judgment to ensure accurate medical cost projections that align with regulatory standards, directly impacting the quality and compliance of client settlements.

Responsibilities

• Review and analyze medical records, billing, payment documentation, and pharmacy histories to determine treatment needs related to injury.
• Prepare concise medical record summary narratives outlining findings and recommendations.
• Apply evidence-based medical treatment guidelines, including CMS guidelines, for future care recommendations.
• Document and support rationale behind findings and case analyses.
• Identify Medicare-covered versus non-Medicare-covered treatments.
• Assign appropriate CPT, HCPCS, and ICD codes based on case details.
• Communicate and collaborate with claims professionals, attorneys, physicians, clients, and internal teams.
• Maintain quality standards and documentation compliance.
• Meet weekly productivity goals ensuring accuracy and regulatory compliance.

Requirements

• Minimum five years’ experience in Medicare Set-Aside preparation and review.
• Graduate of an accredited nursing program (BSN or LPN) or active Registered Nurse license.
• Preferred professional certifications such as MSACP, MSCC, CMSP, CLCP, or CNLCP.
• Minimum five years’ experience in case management, utilization review, or claims management.
• Proficiency in Microsoft Office Suite (Word, Excel).
• Strong analytical skills, attention to detail, and ability to multitask in a high-volume environment.
• Excellent written and verbal communication skills.
• Strong organizational and time management abilities.
• Capability to work independently and collaboratively.

Benefits

• 100% Employer-Paid Medical Insurance for employees
• Dental & Vision Coverage
• 401(k) with Company Match
• Company-Paid Life Insurance
• Optional Short Term Disability and Accident Insurance
• Paid Time Off and Holidays
• Supportive and team-oriented culture