Technical Medical Specialist - PN: 20068627

State of Ohio • Columbus, OH

11d • Hybrid

About The Position

The Technical Medical Specialist manages and leads all Credential Review department day-to-day operations. This role supervises staff and works closely with provider enrollment and other internal areas. The specialist leads and executes all provider network disciplinary actions and related processes, serving as the lead expert in provider non-compliance processing and determinations. Responsibilities also include credential review research and related policy/rule input and recommendations, as well as guiding and designing department strategic direction for overall departmental efficiencies. The State of Ohio is a drug-free workplace and prohibits the use of marijuana. This position may be subject to additional restrictions. Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities, committed to providing access and inclusion and reasonable accommodation in accordance with the ADA and other applicable laws.

Requirements

• 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.
• Knowledge of public & human relations; government structure & process
• Knowledge of BWC, Divisional & Departmental policies & standard operating procedures
• Knowledge of 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 personal computer; MS Software (e.g., Microsoft Office products including TEAMS)
• Skill in PEACH provider database and document management system
• Skill in BWC claims system
• Skill in Sharepoint
• Skill in BWC billing system
• Skill in OhioBWC.com
• Ability to write technically correct & accurate reports
• Ability to use proper research methods in gathering data
• Ability to interpret workers’ compensation claims & BWC medical initiatives
• Ability to 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
• Ability to deal with many variables & determine specific action
• Ability to add, subtract, multiply & divide whole numbers, fractions, decimals & percentages
• Ability to serve as technical resource

Nice To Haves

• Leadership and Management Skills

Responsibilities

• 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

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) & Optional Deferred Compensation (Ohio Deferred Compensation)

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree