Professional Provider Reimbursement Policy Manager (Technical Medical Specialist) - PN: 20068616

Job Title: Professional Provider Reimbursement Policy Manager (Technical Medical Specialist) – PN: 20068616 (260003V5) Organization Workers' Compensation Work Location William Green Building, 30 West Spring Street, Columbus 43215-2256 Primary Location United States of America - OHIO - Franklin County - Columbus Compensation $39.22 - $55.99 per hour Schedule Full‑time, 40 hours per week Primary Job Skill Health Administration Technical Skills Regulatory Compliance, Health Administration, Medical Professional Skills Análisis, Attention to Detail, Ethics and Values, Teamwork, Written Communication Responsibilities Lead the development and maintenance of the Professional Provider and Medical Services (PPMS) and other assigned fee schedules (IPPS, OPPS, ASC) aligning with relevant National (i.e., Medicare) and private payer’s methodologies. Design and implement medical and reimbursement policies to ensure accurate, efficient, and effective PPMS reimbursement systems. Analyze operations and systems to identify improvements and assess the impact of reimbursement methodologies on administrative functions. Deliver training sessions for Managed Care Organizations (MCOs) and providers to support accurate billing and administration. Serve as the lead expert responding to inquiries and reimbursement approval requests related to PPMS methodologies or other assigned fee schedules. Qualifications Certified medical coder in current procedural terminology (CPT) hospital coding, or current ICD coding system; 12 months experience in writing medical policies & procedures for medical provider or insurance company; and 12 months practical experience in health care field. Or completion of undergraduate program core coursework in pre‑medicine, allied medical field, nursing or related field of study; with 12 months practical experience in health care field; and 12 months experience in writing medical policies & procedures for medical provider or insurance company. Or completion of graduate core program in health care administration; and 12 months experience in medical policy development for medical provider or insurance company. Or equivalent of Minimum Class Qualifications for Employment noted above. Job Skills: Information Technology. Major Worker Characteristics Knowledge of: policy and procedure research and development including Medicare, Federal and State reimbursement regulations, other payer and State reimbursement systems, healthcare laws, regulations and standards; BWC, Divisional & Departmental policies & standard operating procedures; OAC (4123 & 4125) & Ohio Revised Code (4121 & 4123) sections mandating workers’ compensation & provider reimbursement; coding and medical terminology as related to billing and reimbursement: HCPCS & CPT coding; International Classification of Diseases, 10th revisions, Clinical Modification (ICD‑10‑CM); financial and statistical analysis including application of analytics to gather, collate, classify information and problem solve about data, people or things, perform process and outcome analysis, development of complex reports using data warehouse technology and computer software. Public & human relations; government structure & process; accounting, finance; healthcare delivery systems and health science administration; health information systems and database management. Skill in: personal computer; BWC software (e.g. Microsoft Office products); written and oral communication; project management; data collection; analysis and data presentation (spreadsheets, charts, graphs); data warehouse reporting; use of ICD and CPT publications. Ability to: define problems, collect data, establish facts and draw conclusions, draft and/or edit administrative policies, procedures and directives utilizing Federal methodologies (e.g. Medicare); use investigative, communication and analytical skills to problem solve and develop policy recommendations related to reimbursement; interpret workers’ compensation claims; use statistical analysis and incorporate into fee schedule and reimbursement policy development; analyze hospital, facility and provider bills according to Medicare Prospective Payment System (PPS); apply principles to solve practical, everyday problems; represent, oversee and guide high‑volume work unit; deal with a variety of variables in somewhat unfamiliar context; use proper research methods in gathering data; create and interpret complex spreadsheets and analyses; maintain accurate records and databases; prepare meaningful, concise and accurate reports; develop and understand process flows; establish friendly rapport with internal and external customers; effectively communicate and prepare and deliver speeches before specialized audiences and general public; handle sensitive inquiries from and contacts with officials, TPAs, MCOs, providers and general public. Benefits 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) and optional Deferred Compensation (Ohio Deferred Compensation) 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, please contact the ADA mailbox View email address on click.appcast.io. 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 beginning after five (5) years of state service. 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. #J-18808-Ljbffr State of Ohio