Technical Medical Specialist - PN

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:

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

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.

Job Skills: Leadership and Management Skills

Major Worker Characteristics:

Knowledge of: (11a) public & human relations; government structure & process* (13a & 13b) BWC, Divisional & Departmental policies & standard operating procedures*; (14) 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: (25b) personal computer; MS Software (e.g., Microsoft Office products including TEAMS) *.(PEACH provider database and document management system* BWC claims system*, Sharepoint* BWC billing system* OhioBWC.com*

Ability to: write technically correct & accurate reports; use proper research methods in gathering data; interpret workers’ compensation claims* & BWC medical initiatives; read, (32q) 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; (30r) deal with many variables & determine specific action; (31d) add, subtract, multiply & divide whole numbers, fractions, decimals & percentages; serve as technical resource.