Medicare Compliance Specialist - Medicare Set-Aside

Role: Medicare Compliance Specialist (Medicare Set-Aside)

BCM Law, P.C. is seeking an experienced Medicare Compliance Specialist to join its Medicare Compliance Practice Group. The role is focused on Medicare Secondary Payer (MSP) compliance and Medicare Set-Aside (MSA) work for workers’ compensation matters, including CMS submissions and approval management.

Responsibilities

• Prepare Medicare Set-Aside (MSA) allocations and future medical cost projections for workers’ compensation settlements.
• Review medical records, treatment histories, pharmacy records, and payment data to create accurate and defensible MSA allocations.
• Draft and submit MSA proposals through the CMS Workers’ Compensation Medicare Set-Aside Portal.
• Respond to CMS development letters and manage submissions through the approval process.
• Evaluate case facts to determine methods of protecting Medicare’s interests.
• Assist with Medicare conditional payment and Medicare Advantage resolution.
• Monitor CMS guideline updates and approval trends to maintain compliance.
• Collaborate with the firm’s Medicare attorneys to support settlement strategy.
• Participate in MSP industry education/professional organizations (e.g., MSPN) and support client education efforts.

Requirements

• 3–5+ years of experience in Medicare Secondary Payer compliance, Medicare Set-Aside preparation, and CMS submission coordination.
• Strong working knowledge of the Medicare Secondary Payer Act and CMS guidelines.
• Direct experience with the CMS Workers’ Compensation Set-Aside Web Portal, submission process, and development letter responses.
• Experience analyzing medical records, treatment histories, and payment data to project future medical exposure.
• Experience communicating with Medicare and Medicare Advantage contractors to resolve conditional payment issues.
• Strong oral and written communication skills.
• Excellent organization, attention to detail, and ability to manage a high-volume caseload independently.

Nice-to-haves

• MSCC and/or CMSP designation strongly preferred.
• Workers’ compensation defense experience strongly preferred.