WCRC Attorney - Remote - 1099

Capitol Bridge's Isabela, Puerto Rico site invites talented individuals to join us as Workers’ Compensation Review Contractor (WCRC) to support an important government project. In this role you will, in accordance with CMS guidelines, evaluate Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) proposals and project the future medical costs, including prescription drugs, related to the workers’ compensation (WC) injury, illness, or disease that would be otherwise reimbursable by Medicare. 

Job Description:  

Review and evaluate workers’ compensation Medicare set-aside (WCMSA) proposals, including medical records, to determine if the proposal meets Medicare threshold requirements and adequately considers Medicare’s interests as pertaining to future medical needs of beneficiaries. Ensure all basic documentation requirements are available or requested via development action prior to making a determination. Render determinations based on professional experience. Implement Medicare policy. Other duties as assigned by management.  

Qualifications:  

• Bachelor’s degree in Nursing (BSN) or a higher-level medical degree from an accredited college or university, and/or a Juris Doctor (JD) from an accredited law school, required.  

• At least 1 year of Medicare Set-Aside (MSA) or related experience, required.  

• Medical record review experience, required.  

• Possess medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and hospital inpatient and outpatient coding, preferred. 

• Medicare Set-Aside Certified Consultant (MSCC) certification and/or Certified Medicare Secondary Payer (CMSP) certification, preferred.    

Reasonable Accommodation  

If you require alternative methods of application or screening, you must approach the employer directly to request this. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned. 

EEO Statement 

Capitol Bridge is an Equal Opportunity Employer. All employment decisions at CB are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.