Position Summary:
The Clinical Support Specialist supports the clinical team by performing a variety of administrative and analytical tasks that contribute to the team’s overall production efforts. Responsibilities include activities such as pricing services, compiling and organizing medical records, and preparing preliminary reviews of case documents.
This role requires the ability to learn and understand Medicare Set-Aside (MSA) processes, work efficiently in a task-driven, high-productivity environment, and demonstrate strong analytical abilities, attention to detail, and clear communication skills. The Clinical Support Specialist plays an important role in ensuring cases are accurately prepared and ready for clinical review.
Conduct a preliminary case review prior to assigning files to the Nurse Allocator by reviewing medical records, payment histories, pharmacy records, and related documentation to confirm all necessary materials have been received for accurate allocation development.
Identify missing information or documentation and communicate with the client to obtain clarification prior to case completion.
Extract, organize, and categorize medical records from client systems as required.
Prepare and maintain allocation templates and supporting documentation.
Prioritize and coordinate workflow by assigning cases to Nurse Allocators and monitoring task progress.
Price future care recommendations within allocations using established pricing resources and systems.
Assist in preparing treating physician statements to be provided to clients upon completion of allocations.
Support the preparation of allocation reports by reviewing and summarizing medical records, billing records, and medical and pharmacy payment histories to outline an injured individual’s past, current, and future treatment needs related to the injury.
Review and extract medical records required for rated age submissions and prepare documentation requests to obtain necessary information.
Provide additional administrative and case support to the Clinical Support Supervisor as needed.
Qualifications & Skills
Proficiency in Microsoft Office Suite, including Word and Excel for document preparation and data management.
Ability to effectively multitask in a high-volume environment while maintaining accuracy and attention to detail.
Excellent written and verbal communication skills with the ability to clearly convey information.
Ability to meet designated deadlines in a fast-paced, production-driven environment.
Strong interpersonal, organizational, and time management skills.
Ability to work independently as well as collaboratively within a team environment.
Demonstrated strong attention to detail and commitment to quality.
Professional certification such as MSCC, CMSP, CLCP, or CNLCP preferred.
5+ years of Medicare Secondary Payer (MSP) clinical experience preferred.
1–3 years of experience in the insurance industry preferred.
What We Offer You
We believe in supporting our team both professionally and personally. Our benefits include:
- 100% Employer-Paid Medical Insurance for employees
- Dental & Vision Coverage
- 401(k) with Company Match
- Company-Paid Life Insurance
- Optional Short Term Disability, Accident Insurance and more
- Paid Time Off & Holidays
- Supportive and team-oriented culture