Credential Review & Provider Network Lead

Taleo; Columbus (OH); On-site; USD 55,000 - 80,000; Full time

Benefits offered by this job

Medical Coverage

Paid time off

Education opportunities

Public retirement system

Job summary

The Ohio Bureau of Workers’ Compensation (BWC) in Columbus seeks a Technical Medical Specialist to oversee Credential Review operations and supervise staff. You will coordinate provider enrollment, disciplinary actions, and non-compliance determinations while applying medical policy knowledge to ensure accurate credentialing.

Ideal candidates will have medical coding experience, policy development skills, and the ability to improve departmental efficiency.

Qualifications

• Certified medical coder in CPT hospital coding or ICD coding system with 12 months of policy writing experience in health care or insurance.
• Undergraduate program core coursework in pre-medicine, allied medical field, nursing or related field with 12 months of health care policy experience.
• Graduate program in health care administration with 12 months in medical policy development.

Responsibilities

• Manage and lead Credential Review day-to-day operations.
• Supervise staff and collaborate with provider enrollment and internal areas.
• Lead provider network disciplinary actions and related processes.
• Serve as lead expert in provider non-compliance processing/determinations.
• Perform credential review research and contribute policy input.
• Guide department strategy for overall efficiencies.

Skills

Attention to Detail

Leadership & Management

Health Administration

Written Communication

Time Management

Ethics & Values

Tools

Teams

Microsoft Office

SharePoint

PEACH provider database

BWC claims system

OhioBWC.com

Job description

The Ohio Bureau of Workers’ Compensation (BWC) in Columbus seeks a Technical Medical Specialist to oversee Credential Review operations and supervise staff. You will coordinate provider enrollment, disciplinary actions, and non-compliance determinations while applying medical policy knowledge to ensure accurate credentialing.

Ideal candidates will have medical coding experience, policy development skills, and the ability to improve departmental efficiency.