Submissions Planner

ECS was formed in 2014 from the acquisition and consolidation of two pillars within the Medicare Secondary Payer (MSP) compliance industry: Gould & Lamb, providers of MSP compliance and reporting services, and MedAllocators/Ability Services Network, a national provider of MSP compliance and case management. Launched as Examworks Clinical Solutions, the new company offered unprecedented, integrated services aimed at managing high dollar complex Medicare, medical, and pharmaceutical claims. In May 2020, the organization name was changed to ExamWorks Compliance Solutions. A single word change, but one that truly reflects the core of what is offered by ECS. Today, our mission remains focused on providing the most comprehensive, creative, and customizable compliance and reporting solutions for the marketplace.

Do you want to contribute to a dynamic, values-oriented workplace? If so, you’ll fit right in with the team at ExamWorks Compliance Solutions (ECS). The Submissions Planner works autonomously to develop any and/or all of the following: Medicare Set-Aside Allocations, production of CMS submissions of Medicare Set Aside Allocations, Bill Reviews and other reports as needed within their scope of licensing and/or certifications. This is a full-time 100% remote position, Monday-Friday, 8:30am - 5:00pm. Must have Medicare Set-aside Certified Consultant (MSCC).

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 collaborate with all company personnel as needed; including communicating with the accounts and attorneys as needed. Conducts research on Medicare expenses allowed in appropriate state for workers’ compensation and keeps abreast of all changes in law and Centers for Medicare/Medicaid Services guidelines. 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. 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.