RESEARCH AND TRAINING SPECIALIST - 43003011

State of Florida

2d•$45,060 - $95,284

About The Position

This is professional work providing management consulting services for the Division of Workers’ Compensation, Bureau of Monitoring & Audit 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, claims and policy data collected by the Division. The Research & Training Specialist will carry out all required processes and communications with medical submitters, Trading Partners, insurers and/or claim administrators to ensure electronic reporting compliance in accordance with Chapter 440 and Administrative Codes. Conducts investigations to acquire facts needed to resolve electronic medical bill, policy and claims rejections regarding filing requirements. Communicates rejection information via email (or telephone when needed) outlining required corrections. Responsible for reviewing insurers, Trading Partners, and medical submitters performance. Investigates complaints regarding violations of the law and Division Rules as assigned by the Operations & Management Consultant Manager. Monitors carrier practices by identifying and documenting violation trends and provides recommendations to the Operations & Management Consultant Manager. Assists Operations & Management Consultant Manager and Regulatory Analyst Supervisors with identifying the need for internal program modifications. Conducts testing for enhancements made to ensure compliance with program design.

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 from an accredited college or university may substitute for the required work experience.
Three (3) years or more of regulatory experience.
Three (3) years or more of experience working with Microsoft Office (Outlook, Word, Excel, and PowerPoint)
Three (3) years or more of data analysis.
Knowledge of data collection methods; problem-solving techniques; data analysis; and management principles.
Ability to apply investigative principles and techniques; review, analyze and evaluate data; collect, analyze, and interpret data; organize data into logical format for presentation in reports and other written materials.
Ability to understand and apply applicable rules, regulation, policies, and procedures relating to management analysis practices; understand and apply workers’ compensation statutes, rules, and procedures; examine and evaluate data related to workers’ compensation programs.
Ability to conduct fact finding investigations; conduct interviews; and prepare and maintain statistical data and reports.
Ability to handle conflict and disputes in a professional and courteous manner.
Demonstrated knowledge, understanding, and application of Chapter 440, FL Statutes, and related rules.
Skill in using personal computer and Microsoft programs.
Ability to communicate verbally and in writing; utilize deductive reasoning; establish and maintain effective working relationships with others.
Ability to meet performance expectations.

Nice To Haves

Two (2) years or more of leadership experience.
One (1) year or more experience with International Association of Industrial Accident Boards and Commissions (IAIABC) Claims EDI Release 3.
Two (2) years or more of experience interpreting rules, regulations, policies, and procedures.
Two (2) years or more of experience in workers’ compensation medical and claims data collection.
Two (2) years or more of experience creating training documents and presenting information.
Two (2) years or more of experience utilizing investigative techniques and practices.
Two (2) years or more of Electronic Data Interchange (EDI) knowledge and experience.

Responsibilities

Provides technical assistance and serves as a liaison to medical submitters, Trading Partners, insurers and claim administrators with questions relating to the Workers’ Compensation law and claims handling practices.
Trains medical submitters, Trading Partners, insurers and claim administrators on program filing specifications.
Trains team members on WC processes and procedures, statute and rules, EDI and WC history.
Responds to customer training requests for extensive knowledge of workers’ compensation.
Investigates cases to determine questionable claims handling practices by medical submitters, Trading Partners, and insurers in accordance with Florida Statutes.
Assists Operations & Management Consultant Manager and Regulatory Analyst Supervisor with monitoring 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.
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, implementation guides, etc.
Assist the Operations & Management Consultant Manager and Regulatory Analyst Supervisor with conducting research to analyze program user needs, program hindrances and other issues impacting operating practices.
In conjunction with the Operations & Management Consultant Manager and Regulatory Analyst Supervisor, participates in team projects and training aimed at improving data collection techniques and practices.
Reports critical problems to Operations & Management Consultant Manager and Regulatory Analyst Supervisor when delays in resolution interfere with daily production.
Assists Operations & Management Consultant Manager and Regulatory Analyst Supervisor with issues stemming from national EDI development committee meetings.
Performs work independently, subject to review by the Operations & Management Consultant Manager.
Follows Department Internal Controls Policy and Bureau procedures/instructions to ensure confidential information accessed is secured and not disclosed outside of position duties.
Performs other related duties as required.