MSP Compliance Specialist - Eastern Alliance

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We protect others. Choosing a place to apply your talents is an important decision for anyone. You have plenty of options. Why choose Pro Assurance?

At Pro Assurance, we sell a pledge, and that pledge is delivered by our team members. We are seeking individuals who value integrity, leadership, relationships, and enthusiasm—and want to build their career with a great company where they can be their authentic self and feel valued, recognized, and rewarded for their contributions. Pro Assurance specializes in healthcare professional liability, products liability for medical technology and life sciences, legal professional liability, and workers' compensation insurance.

We are an industry-leading specialty insurer, with job opportunities in much of the contiguous United States.

This position supports our workers' compensation line of business, Eastern Alliance, and is hybrid, reporting to any of our Eastern Alliance office locations approximately 2 days per month. The primary responsibility of this position is to ensure the Company's compliance with the CMS mandatory insurer reporting requirements for Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Medicare Secondary Payer Act under the direction of management.

Responsibilities of this position include managing all CMS data elements aspects for WC claims, including verifying data points and managing CMS related inquiries, including, but not limited to, conditional payment notices (CPNs) and Medicare Advantage liens under moderate supervision, following established Company requirements and procedures for reporting Section 111 for Ongoing Responsibility for Medicals (ORM) and Total Payment Obligation to Claimants (TPOC) timely and accurately.

What you'll do:

• 40% - Timely, accurately, and in accordance with statutory guidance and timelines, conduct research and inputs required Section 111 data elements into WCXP/Compliance fields required for quarterly submission to CMS. Ongoing Responsibility for Medical (ORM) accepted ICD code/diagnoses, and Total Payment Obligation to Claimant (TPOC)/settlement details on claims for Medicare eligible Injured Workers.
• 25% - Proactively manage and update the WCXP CMS Compliance claim data elements required for termination of Ongoing Responsibility for Medical (ORM) within each jurisdiction's statute of limitations for medicals, and in compliance with the CMS Non-group health plan (NGHP) reference guide. Establish and maintain a diary task to monitor timely and accurate ORM and ORM termination for Medicare eligible claim files.
  
  Understand and maintain current knowledge and expertise on the statutory rules around termination of benefits in each jurisdiction.
• 10% - Coordinate and resolve missing data elements or errors with the claim representative. Document the Section 111 activity in a claim note in accordance with best practices.
• 15% - Monitor and handle incoming CMS correspondence and Medicare Beneficiary inquiries related to CMS development letters, conditional payment liens notices, and Medicare Advantage lien(s) under the direction of management. Direct the issuance of payments as appropriate.
• 5% - Maintain knowledge of CMS requirements for Section 111 reporting Attends business unit, department, and company meetings.
• 5% - Assist with Company projects assigned and continue professional growth and development through attendance and participation in insurance related events/functions, seminars, classes, and conferences.

What we're looking for:

• Bachelor's degree is required; a High School Diploma/GED with a minimum of eight years of experience working in a medical, legal, or insurance environment can replace the bachelor's degree requirement.
• A minimum of three years of experience in workers' compensation claims.
• Strong working knowledge of medical terminology, common medical procedures, and treatments.
• Extensive knowledge of workers' compensation processes and procedures, with strong working knowledge of applicable state laws.
• Working knowledge of CMS reporting requirements preferred.
• Proficiency in Microsoft Office computer applications,…