Technical Medical Specialist - PN: 20068627

Ohio BWC (official); Columbus (OH); On-site; USD 84,000 - 120,000; Full time

Job summary

BWC in Columbus, Ohio is seeking a Credential Review Manager to lead the Credential Review department’s day‑to‑day operations. You will supervise staff, collaborate with provider enrollment, and oversee disciplinary actions and related processes.

Ideal candidates have CPT/ICD coding experience, health‑care policy development, and strong writing skills for policy and procedure documentation. This is an on‑site role with a 40‑hour week and a salary range of $40.40–$57.67 per hour.

Qualifications

• CPT hospital coding or ICD coding experience; 12 months writing medical policies & procedures for medical provider or insurance company.
• Undergraduate or graduate program requirements as noted above; 12 months exp in healthcare field.

Responsibilities

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

Skills

Leadership and Management

Education

Undergraduate coursework in pre-medicine / allied medical field

Graduate program in health care administration

Equivalent Minimum Class Qualifications for Employment

Tools

PEACH provider database

BWC claims system

SharePoint

OhioBWC.com

Job description

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

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, (32q) 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; (30r) deal with many variables & determine specific action; (31d) add, subtract, multiply & divide whole numbers, fractions, decimals & percentages; serve as technical resource.

Organization

Workers' Compensation

Agency Contact Name and Information

Matthew Palte- HCM Sr. Analyst: [e-mail]

Work Location

William Green Building

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation

$40.40 - $57.67

Schedule

Full-time

Work Hours

40

Classified Indicator

Classified

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

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.

Our Culture

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.

Our Vision

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

Our Mission

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

Our Core Values

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