Technical Medical Specialist - PN: 20068627

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

Job Description - Technical Medical Specialist - PN: 20068627 (260006OC)

Technical Medical Specialist - PN: 20068627 ( 260006OC )

Organization

Workers' Compensation

Agency Contact Name and Information : Matthew Palte- HCM Sr. Analyst: [e-mail]

Work Location

William Green Building 30 West Spring Street Columbus 43215-2256

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation : $40.40 - $57.67

Schedule

Full-time

Work Hours : 40

Union : Exempt from Union

Primary Job Skill

Health Administration

Technical Skills : Medical

Professional Skills : Attention to Detail, Ethics and Values, Time Management, Written Communication

Agency Overview

A Little About Us:
With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers.
For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.

BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.

To transform BWC into an agile organization driven by customer success.

To deliver consistently excellent experiences for each BWC customer every day.

One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.

BWC’s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC’s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.

What Our Employees Have to Say:

• BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.
• I have worked at several state agencies and BWC is the best place to work.
• Best place to work in the state and with a sense of family and support.
• I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.
• I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.

What You’ll Be Doing:

• Manages and leads all Credential Review department day-to-day operations
• Supervises staff and works closely with provider enrollment and other internal areas
• Leads and executes all provider network disciplinary actions and related processes
• Serves as lead expert in provider non-compliance processing/determinations
• Responsible for credential review research and related policy/rule input and recommendations
• Guides and designs department strategic direction for overall departmental efficiencies

Why Work for the State of Ohio

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website ! Our benefits package includes:

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) &Optional Deferred Compensation ( Ohio Deferred Compensation )

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

Certified medical coder in current procedural terminology (CPT) hospital coding, or current icd coding system; 12 mos. exp in writing medical policies & procedures for medical provider or insurance company; 12 mos. practical exp in health care field.
-Or completion of undergraduate program core coursework in pre-medicine, allied medical field, nursing or related field of study; 12 mos. practical exp. in health care field; 12 mos. exp. in writing medical policies & procedures for medical provider or insurance company.
-Or, completion of graduate core program in health care administration; 12 mos. exp. in medical policy development for medical provider or insurance company.
-Or equivalent of Minimum Class Qualifications for Employment noted above.
Job Skills: Leadership and Management Skills

Major Worker Characteristics:

Knowledge of: (11a) public & human relations; government structure & process* (13a & 13b) BWC, Divisional & Departmental policies & standard operating procedures*; (14) Government Structure & Procedures : OAC (4123 & 4125) & Ohio Revised Code (4121 & 4123) sections mandating workers’ compensation & provider reimbursement, BWC billing methodology*,statistical analysis; BWC medical and departmental policies & procedures; medical terminology; ICD-9 & ICD-10 coding for medical diagnoses, assignments & groupings, communications.

Skill in: (25b) personal computer; MS Software (e.g., Microsoft Office products including TEAMS) *.(PEACH provider database and document management system* BWC claims system*, Sharepoint* BWC billing system* OhioBWC.com*

Ability to:write technically correct & accurate reports; use proper research methods in gathering data; interpret workers’ compensation claims* & BWC medical initiatives; read, understand, analyze & interpret extensive variety of technical materials , manuals, law books (e.g.,Codes), spreadsheets & on-line & synthesize the information into concise, accurate & comprehensible BWC documents; deal with many variables & determine specific action; add, subtract, multiply & divide whole numbers, fractions, decimals & percentages; serve as technical resource.

Supplemental Information

EEO & ADA Statement:
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.

The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, pleasecontact the ADA mailbox [e-mail] .

Salary Information

Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.

Educational Transcripts:
For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.

All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.

Background Check

Prior to an offer of employment , the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.

ADA Statement

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Drug-Free Workplace

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.