REGULATORY ANALYST III - 43003123

State of Florida

About The Position

This is professional work providing management consulting services for the Division of Workers’ Compensation, Bureau of Monitoring and Audit, Insurer Reporting Services Section to improve management capabilities and operational procedures related to the design, management, documentation and evaluation of processes involved in the collection, quality control, storage and reporting of medical and claims data collected by the Division. Responds to customer requests requiring extensive knowledge of workers’ compensation. Performs work independently, subject to review by immediate supervisor and/or team leader. Promotes the Division’s medical and claims data programs through various marketing strategies, including Internet (web site), e-mail, telephone, presentations, and written correspondence. Follows Department Internal Controls Policy and Bureau procedures/instructions to ensure confidential information accessed is secured and not disclosed outside of position duties. Educates trading partners in program filing specifications. Assure that data collection strategies meet their needs for monitoring carrier performance and assessing penalties for noncompliance. Suggest system improvements to address those specific needs. Monitors performance of servers involved in daily processing of electronic submissions in order to assure consistent functionality and adequate capacity in moving electronically submitted claims continuously through the system, without delays or backlogs. Reports critical problems to supervisor and management when delays in resolution interfere with daily production. Provides prompt technical assistance to medical data submitters. Participates in meetings and teleconferences with Supervisor and EDI insurers to discuss EDI program deficiencies and expected outcomes. Creates and maintains documentation on various EDI transaction filing requirements for the State of Florida, including electronic filing manuals, data element requirements, edit matrixes, event criteria, program edits, trading partner agreements, etc (FL EDI Implementation Manual). Develops, reviews and edits written operating procedures, flow charts, position descriptions, training guides, etc. for EDI Team processes to ensure completeness, accuracy and comprehension of content. Develops, reviews, and updates documentation for various instructional materials, articles for newsletters, presentations, and web site. Responds to ad hoc requests from management, the legislature, and internal/external customers by extracting information from the medical database for analysis of trends, as needed, using appropriate software or coordinating with technical staff. Prepare management reports related to processing of data, as needed. Maintains organized records of work performed. Maintains a record of communications with individuals, teams, Division bureaus, ACHA, IAIABC, and other program users, including both internal and external customers. Produces documents, letters, and other correspondence relating to the development and design of data (Medical, Claims and POC) collection systems, business issues, workflow diagrams, etc. Reviews and analyzes state and national workers’ compensation medical and claims data collection programs for compliance with federal requirements, state statutes and associated rules, correlation with Division needs, and alignment with Division goals/objectives, in order to develop and maintain more efficient and effective data management systems. Evaluates and monitors, data collection and management capabilities and corresponding operational procedures and rules associated with medical and claims data collection processes. Tests program modifications requested to ensure compliance with program design. Creates procedures geared towards achieving increased reliability and accuracy of data collection efforts and consistency between various division electronic programs and computer systems, including the Division’s Integrated System database. Identifies the need for and recommends medical and Integrated program modifications. Evaluates the impact of program amendments on Division operations and goals. Detects and reports actual or possible encumbrances/obstacles in existing or planned programs and resultant consequences, if not changed. Recommends solutions and improvements to promote data collection and integrity for meeting operational objectives of the Division. Evaluates and measures the effectiveness of existing system designs against desired program objectives to determine if changes are necessary. Conducts special studies, surveys and other issues impacting operating practices. Provides management consulting services to supervising administrator and other Division managerial personnel on business data needs, process improvements relating to Division rules, operating procedures, user guides, and other data management programs. Participates in EDI teleconferences, meetings and webinars with trading partners. Assists supervisor with issues stemming from national EDI development committee meetings, e.g., address and reconcile concerns with format design and content (particularly Release III). Educates trading partners in EDI program filing specifications. Participates on other projects/teams aimed at furthering improved/standardized data quality and collection techniques and practices. Performs work independently, subject to review by immediate supervisor. Performs related work as required.

Requirements

Four (4) years of experience in a relevant field (risk management, insurance, claims handling, medical billing and reporting, financial accounting, or auditing) is required.
A post-secondary degree may be used as an alternative for years of experience on a year-for-year basis.
Knowledge of data collection methods; problem-solving techniques; data analysis; and management principles.
Ability to examine and evaluate data relating to a workers' compensation program, to understand and apply applicable rules, regulations, policies and procedures relating to a workers' compensation program
Knowledge of the methods of data collection and analysis
Ability to collect, evaluate and analyze data to develop alternative recommendations, solve problems, document work flow and other activities relating to the improvement of management practices
Ability to organize data into logical format for presentation in reports, documents and other written materials, to conduct fact find-solving techniques, to plan, organize and coordinate work assignments, to communicate effectively, to establish and maintain effective working relationships with other.
This position requires a security background check, including fingerprint as a condition of employment.

Nice To Haves

Two (2) years of experience using Microsoft Office (Outlook, Word, Excel, and PowerPoint in a professional environment.
Two (2) years of experience interpreting rules, regulations, policies, and procedures.
Two (2) years of regulatory enforcement experience.
Two (2) years of experience in workers’ compensation medical and claims data collection.
Two (2) years of Electronic Data Interchange (EDI) knowledge and experience.
Experience in International Association of Industrial Accident Boards and Commissions (IAIABC) Claims EDI Release 3.

Responsibilities

Responds to customer requests requiring extensive knowledge of workers’ compensation.
Promotes the Division’s medical and claims data programs through various marketing strategies, including Internet (web site), e-mail, telephone, presentations, and written correspondence.
Educates trading partners in program filing specifications.
Monitors performance of servers involved in daily processing of electronic submissions in order to assure consistent functionality and adequate capacity in moving electronically submitted claims continuously through the system, without delays or backlogs.
Provides prompt technical assistance to medical data submitters.
Participates in meetings and teleconferences with Supervisor and EDI insurers to discuss EDI program deficiencies and expected outcomes.
Creates and maintains documentation on various EDI transaction filing requirements for the State of Florida, including electronic filing manuals, data element requirements, edit matrixes, event criteria, program edits, trading partner agreements, etc (FL EDI Implementation Manual).
Develops, reviews and edits written operating procedures, flow charts, position descriptions, training guides, etc. for EDI Team processes to ensure completeness, accuracy and comprehension of content.
Develops, reviews, and updates documentation for various instructional materials, articles for newsletters, presentations, and web site.
Responds to ad hoc requests from management, the legislature, and internal/external customers by extracting information from the medical database for analysis of trends, as needed, using appropriate software or coordinating with technical staff.
Prepare management reports related to processing of data, as needed.
Maintains organized records of work performed.
Maintains a record of communications with individuals, teams, Division bureaus, ACHA, IAIABC, and other program users, including both internal and external customers.
Produces documents, letters, and other correspondence relating to the development and design of data (Medical, Claims and POC) collection systems, business issues, workflow diagrams, etc.
Reviews and analyzes state and national workers’ compensation medical and claims data collection programs for compliance with federal requirements, state statutes and associated rules, correlation with Division needs, and alignment with Division goals/objectives, in order to develop and maintain more efficient and effective data management systems.
Evaluates and monitors, data collection and management capabilities and corresponding operational procedures and rules associated with medical and claims data collection processes.
Tests program modifications requested to ensure compliance with program design.
Creates procedures geared towards achieving increased reliability and accuracy of data collection efforts and consistency between various division electronic programs and computer systems, including the Division’s Integrated System database.
Identifies the need for and recommends medical and Integrated program modifications.
Evaluates the impact of program amendments on Division operations and goals.
Detects and reports actual or possible encumbrances/obstacles in existing or planned programs and resultant consequences, if not changed.
Recommends solutions and improvements to promote data collection and integrity for meeting operational objectives of the Division.
Evaluates and measures the effectiveness of existing system designs against desired program objectives to determine if changes are necessary.
Conducts special studies, surveys and other issues impacting operating practices.
Provides management consulting services to supervising administrator and other Division managerial personnel on business data needs, process improvements relating to Division rules, operating procedures, user guides, and other data management programs.
Participates in EDI teleconferences, meetings and webinars with trading partners.
Assists supervisor with issues stemming from national EDI development committee meetings, e.g., address and reconcile concerns with format design and content (particularly Release III).
Educates trading partners in EDI program filing specifications.
Participates on other projects/teams aimed at furthering improved/standardized data quality and collection techniques and practices.
Performs work independently, subject to review by immediate supervisor.
Performs related work as required.