MCO Contract Control Audit Program Manager - (TMS)

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 You’ll Be Doing:

Under the direction of the Director of the MCO Business Unit, the MCO Contract Control Audit Program Manager will lead the management of ensuring contract compliance of BWC’s 9 managed care organizations. This responsibility includes developing policies and operational controls to ensure the integrity and compliance with security controls and contract terms.

This role includes compiling and reviewing large amounts of data used in the evaluation of control compliance. This role will utilize information gathered by auditors to outline contract violations, and to work with the Medical Services’ leadership and MCO to resolve.

The contract controls manager will work with the contract and audit team to develop the appropriate monitoring tools, and statistical analyses needed to demonstrate contract compliance with controls.

The contract controls manager will facilitate relevant controls training of BWC staff and managed care organizations.

The ideal candidate will be familiar with use of Microsoft Excel. The candidate should also possess an ability to work both independently and to facilitate project teams, and demonstrate a high level of critical thinking and analytical skills.

To Qualify, You Must Clearly Demonstrate:

Required Experience and/or Education:

Completion of graduate core program in health care administration AND 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 AND 12 months practical experience in health care field AND 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 AND 12 months experience in writing medical policies & procedures for medical provider or insurance company AND 12 months practical experience in health care field.

*** THE 12 MONTHS EXPERIENCE WRITING MEDICAL POLICIES & PROCEDURES IS REQUIRED FOR EACH SECTION FOR THE ABOVE MINIMUM QUALIFCATIONS. YOU MUST HAVE THIS IN ADDITION TO THE OTHER MINIMUM QUALIFICATIONS IN THE SECTION ***

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.