Capitol Bridge, LLC.

Evaluate Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) proposals to project future medical costs in accordance with CMS guidelines. Review medical records to ensure proposals meet Medicare threshold requirements and protect Medicare's interests.

The Arbiter is responsible for deciding payment disputes by analyzing documentation and researching federal laws and contract regulations. They must draft concise, defensible determinations and manage complex case files to ensure organizational objectives are met.

Review Medicare Part A and B administrative appeals decisions to identify legal and policy issues. Prepare legal memoranda and coordinate with CMS and other contractors to ensure consistent adjudication of Medicare laws.

The physician will be responsible for resolving claim disputes submitted by various healthcare providers and institutions. They will also provide expert assistance to healthcare plans and providers regarding claim resolution processes.