Submissions Specialist (33286)

Location: 100% Remote
Schedule: Monday – Friday | 8:00 AM – 5:00 PM

About the Role

We are seeking an experienced, detail-oriented professional with Medicare expertise to join our team as a Remote Submissions Specialist. In this critical role, you will oversee Medicare Set-Aside (MSA) Allocations for submission to the Centers for Medicare & Medicaid Services (CMS). You will ensure every file is processed with the highest level of accuracy, integrity, and full compliance with CMS guidelines, client contractual agreements, regulatory standards, and federal/state mandates.

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What You Will Do

• Manage CMS Submissions: Review MSA reports, verify claimant Medicare status, and obtain all necessary documentation—including responding to CMS development letters—to ensure successful submissions.
• Analyze Comprehensive Case Files: Examine medical records alongside payment histories, prescription logs, and legal documents to fully understand each case and identify any missing elements.
• Ensure Quality & Compliance: Revise submissions following quality control reviews and maintain strict adherence to current CMS guidelines, client specifications, and company policies.
• Communicate & Collaborate: Provide clear, accurate verbal and written updates regarding case needs and statuses to claims adjusters, attorneys, and Account Executives.
• Stay Organized & Proactive: Independently and punctually manage diaries for your assigned caseload, run status reports as needed, and offer insights to management regarding report quality and compliance trends.

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Qualifications

Qualifications & Experience

• Education: High school diploma or equivalent required.
• Core Experience: Minimum of 1 year in an administrative role with Medicare Secondary Payer (MSP) experience.
• Industry Background: Minimum of 1 year of experience in Medical, Pharmaceutical, or Insurance.
• Certification: Medicare Set-Aside Certified Consultant (MSCC) certification is preferred, but not required.

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Skills & Knowledge

• Regulatory & Clinical Expertise: In-depth knowledge of current CMS requirements, MSP statutes, medical terminology, medications, and laboratory values.
• Analytical & Math Proficiency: Ability to accurately calculate rates, percentages, and perform basic math across all units of measure using whole numbers and decimals.
• Technical Savvy: Strong proficiency in Microsoft Office Suite (Word, Excel, Outlook) and web-based research/portals.
• Communication Excellence: Exceptional verbal and written communication skills, active listening, and the confidence to ask clarifying questions when needed.

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Why Join Us?

• Work From Home: Enjoy the comfort and flexibility of a 100% remote position.
• Consistent Schedule: Maintain a great work-life balance with standard Monday–Friday business hours.
• Meaningful Impact: Play an essential role in ensuring accuracy and compliance within the Medicare Secondary Payer industry.

Ready to make an impact? Apply today with your updated resume!