CMS Specialist - Tampa, FL or US Telecommute

United Health Group
Sep 22, 2016
Sep 27, 2016
Employer Type
Direct Employer
Employment Type
Full Time
Position Description:

You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.(sm)

Responsible for the production of CMS submissions of Medicare Set Aside Allocations.

Primary Responsibilities:

* Reviews and analyzes medical records and Medical payout information to determine an appropriate Medicare Set Aside (MSA) Allocation for submission to CMS for approval for clients.
* Conducts research on Medical expenses allowed in appropriate state for workers' compensation and keeps abreast of all changes in law and Centers for Medicare/Medicaid Services guidelines.
* According to Services guidelines, writes/updates MSA reports, calculates financial grid for injury- and non-injury-related medical expenses and coordinates with UHG for related pharmaceutical costs.
* Works with claim adjusters to obtain clarification on outstanding issues for MSA/CMS submission.
* Works with claim adjusters and attorneys in negotiating and defending recommended allocations as necessary.
* Works with CMS Coordinators and various departments within the business unit in coordinating daily work deadlines per MSA Services' production standards.
* Maintains level of required quality as determined by leadership done through the QC department in monthly evaluations.
* Maintains a minimum production level as determined by leadership and business needs,.
* Maintains patient privacy and confidentiality under requirements of federal and state law, including HIPAA, and in accordance with policy.


* Associate's degree(or higher) or High School Diploma/GED w/3+ years of office experience
* 2+ years of workers' compensation or liability claims experience or an RN with case management and workers' compensation or liability claims experience
* 1+ years of MSA writing and claim reserve setting experience
* Ability to create and edit documents in MS Word
* Ability to create, edit and input data in MS Excel
* Ability to create and edit presentations in MS PowerPoint
* Must be able to pass MSCC certification within 6 months of accepting the position (Company reimbursed if course is passed).


* Bachelor's Degree in Business Administration or Insurance, Bachelor's of Science
* Catastrophic claims experience
* RN or CLCP License

Soft Skills:

* Ability to analyze and problem solve
* Ability to work in a fast paced environment.
* Excellent written and verbal communication

Physical Requirements and Work Environment:

* Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
* Office environment

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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