Blue Cross and Blue Shield of Louisiana logo
Blue Cross and Blue Shield of Louisiana

We live out our mission to improve the health and lives of Louisianians each day with our friends and neighbors in mind.

MSP Specialist

Support EngineerSupport EngineerFull TimeRemoteMid LevelTeam 1,001-5,000Since 1934H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

4 days ago

Salary

0

Seniority

Mid Level

Job Description

MSP Specialist

Blue Cross and Blue Shield of Louisiana

Role Description The MSP Specialist is responsible for analyzing, researching and resolving CMS Section 111 MSP Response File errors to ensure data exchange compliance. Responsibilities include: - Determining Medicare order of payment and loading the appropriate Medicare COB record. - Researching and determining if 411 reporting to the MSPRC and the CMS COBC is required. - Reviewing, processing and tracking the Small Employer Exception (SEE) approvals from CMS. - Initiating procedures to recover funds from providers, subscribers or beneficiaries where overpayments have occurred. - Complying with all laws and regulations associated with duties and responsibilities. Qualifications - High School Diploma or equivalent is required. - 3 years of claims experience is required. - 1 year of COB, refund or adjustment experience is required. - Medicare experience is preferred. - Expert knowledge in primacy determination, CMS Regulations, COB Rules and Regulations is required. - Knowledge of enrollment process is preferred. - Demonstrated PC skills including Microsoft Office (e.g., Word, Excel, Outlook, etc.) and related software. - Strong verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism. - Able to assist both internal and external customers in a variety of situations. - Detail-oriented and organized. - Able to shift priorities as needed to cover multiple tasks. Requirements - Researching, reviewing, and sending appropriate documentation to Medicare/CMS, the Department of the U.S. Treasury and/or collection agencies. - Meeting all CMS imposed deadlines to ensure compliance and avoid referral to the Department of Treasury. - Reviewing, processing and tracking the Small Group Exception (SEE) approvals from CMS. - Receiving or initiating an MSP 411 investigation from various sources. - Creating MSP 411 reporting letters when necessary. - Maintaining a tracking log of all MSP 411 reported situations. - Determining if Medicare mistakenly made a Primary payment. - Loading appropriate Medicare COB record to ensure accuracy of claims processing. - Reviewing the group threshold report weekly for changes. - Researching and making necessary COB adjustments on claims. - Reviewing quality audits for correction or routing within 48 hours. - Initiating procedures to recover funds from providers, subscribers, or beneficiaries. - Analyzing and correcting MSP response file errors. - Maintaining and recording number of adjustments processed and hours worked daily. Benefits - Resources to live well and be healthy. - Opportunities for continued learning and skill development. - Support for professional growth. - Engagement in serving local communities.

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