ExamWorks Compliance Solutions · 2 weeks ago
Planner (32429)
United States
Full-time
Remote
Mid Level
1+ years expExamWorks Compliance Solutions is seeking a Planner to work autonomously in developing Medicare Set-Aside Allocations and other necessary reports. The role involves analyzing health data, collaborating with personnel, and ensuring compliance with CMS requirements.
ConsultingProperty & Casualty InsuranceHealthcareInsuranceMedical
Responsibilities
Collects, reviews and analyzes health data from medical records and/or other sources as provided
Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care
Work autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed
Maintain a quality work product evidenced by acceptable quality scores/score cards
Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company
Attend all scheduled conference calls as mandated by management
Maintain any required credentials and adhere to all codes of ethics required by these credentials
Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times
Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines
Promote effective and efficient utilization of company resources
Participate in various educational and or training activities as required
Perform professional duties as assigned by the Manager or upper management
Qualification
Required
Knowledge of the disability and workers' compensation industry including rules and regulations and a full understanding of Medicare rules and regulations
Must be able to adequately operate a general computer, fax, copier, scanner, and telephone
Must have adequate knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet
Ability to demonstrate critical thinking and problem solving skills
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed
Must be able to work independently, prioritize work activities and use time efficiently
Ability to concentrate and multitask in a fast paced work environment
Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met
Must be able to maintain confidentiality
Must be able to demonstrate and promote a positive team-oriented environment
Must be able to work well under pressure and/or stressful conditions
Must possess the ability to manage change, delays, or unexpected events appropriately
Must be able/willing to work on a flexible schedule when needs arise
Must possess excellent skills in English usage, grammar, punctuation and style
Demonstrates reliability and abides by the company attendance policy
A minimum of one year experience in Medicare Set Asides required
Will recognize any of the following: Active unrestricted Nursing license (including but not limited to RN, NP LVN, LPN)
Active unrestricted Adjuster license
Certification in Medicare Set Asides and/or certifications in Life Care Planning or Legal Nurse Consulting
Preferred
Minimum of an Associates degree or equivalent certification preferred
A minimum of one years workers' compensation and/or case management experience preferred
Company
ExamWorks Compliance Solutions
ExamWorks Compliance Solutions is a leading authority on Medicare Compliance and Mandatory Insurer Reporting.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Christie Britt
President
Company data provided by crunchbase