Professional Provider Reimbursement Policy Manager (Technical Medical

Schedule: Full-time

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 conducts an internal engagement survey on an annual basis. Some comments from our employees include:

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.

If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!

What You’ll Be Doing:

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 schedule.

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; AND 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; with 12 mos. practical exp. in health care field; AND 12 mos. exp. in writing medical policies & procedures for medical provider or insurance company.

-Or, completion of graduate core program in health care administration; AND 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: 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*; 2) Coding and medical terminology as related to billing and reimbursement: HCPCS and CPT coding; International Classification of Diseases, 10th revisions, Clinical Modification (lCD-10-CM), 3) 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: 1) define problems, collect data, establish facts and draw conclusions, 2) 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*; 3) 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);4) apply principles to solve practical, everyday problems; 5) represent, oversee and guide high-volume work unit; 6) deal with a variety of variables in somewhat unfamiliar context; 7)use proper research methods in gathering data; 8) create and interpret complex spreadsheets and analyses; maintain accurate records and databases, 9) prepare meaningful, concise and accurate reports; 10) develop and understand process flows; 11) establish friendly rapport with internal and external customers; 12) effectively communicate and prepare and deliver speeches before specialized audiences and general public, 13) handle sensitive inquiries from and contacts with officials, TPAs, MCOs, providers and general public. Developed after employment.