Reimbursement Policy Manager (TMS)

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 You’ll Be Doing:

Independently manages Ambulatory Surgery Center (ASC) or other assigned fee schedules, IPPS, OPPS, PPMS) payment program development & maintenance taking into to account relevant National (i.e., Medicare) and private payer’s methodologies.

Plans, directs, develops & implements relevant medical and reimbursement policies in order to maintain an accurate, efficient, effective, and appropriate ASC reimbursement methodology.

Monitors & analyzes operations, systems & procedures to ascertain appropriate improvements & feasibility & or impact of assigned fee schedule reimbursement system on administrative functions.

Execute MCO and provider trainings to facilitate appropriate billing and administration of the assigned fee schedule.

Serve as the lead responder on inquiries and/or reimbursement approval requests submitted to the Medical Policy mailbox for the ASC reimbursement methodology or other assigned fee schedule.

EEO & ADA Statement:

The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.

The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request a reasonable accommodation due to disability, please contact ADA Coordinator Kathleen Bourke at or by email to\: .

Salary Information:

Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.

Transportation:

Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.

Educational Transcripts:

For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.

All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.

Background Check:

Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.

A Little About Us:

With roughly 1,500 employees in 7 offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers.

For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.

Our Culture:

BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC employees strive to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee resource groups, participate in online forums discussing society’s impact on our services and workplace, and learn about how different perspectives can improve leadership skills.

Our Vision:

To transform BWC into an agile organization driven by customer success.

Our Mission:

To deliver consistently excellent experiences for each BWC customer every day.

Our Core Values:

One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.

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.

To Qualify, You Must Clearly Demonstrate:

Required Experience and/or Education:

Completion of graduate core program in health care administration; 12 months experience in medical policy development for medical provider or insurance company.

Or completion of undergraduate program core coursework in pre-medicine, allied medical field, nursing or related field of study; 12 months practical experience in health care field; 12 months experience in writing medical policies & procedures for medical provider or insurance company.

Or certified medical coder in current procedural terminology (CPT) hospital coding, or current ICD coding system; 12 months experience in writing medical policies & procedures for medical provider or insurance company; 12 months practical experience in health care field.

Or equivalent of Minimum Class Qualifications for Employment noted above.

MAJOR WORKER CHARACTERISTICS:

Knowledge of medical/rehabilitation services; health care coverage & reimbursement techniques; health care

administration; cost containment measures; statistical analysis; workers' compensation medical policies & insurance

industry standards*; supervisory principles/techniques*. Skill in operation of personal computer*. Ability to understand

somewhat abstract field of study (i.e., health care); write & edit technical manuals & instructions; create complex reports

using computer software; gather, collate & classify information about data, people or things. Developed after employment.