Columbus - WC Medical Claims Specialist - PN:

Columbus - Wc Medical Claims SpecialistOrganization: Workers' Compensation Agency Contact Name and Information: Matthew Palte- HCM Sr. Analyst: Matthew.P.2@bwc.ohio.gov Work Location: William Green Building, 30 West Spring Street, Columbus 43215-2256 Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $24.16 - $30.55 Schedule: Full-time Work Hours: 40 Classified Indicator: Classified Union: OCSEA Primary Job Skill: Claims Examination Technical Skills: Claims Examination Professional Skills: Analyzation, Attention to Detail, Ethics and Values, Written Communication A Little About Us: With roughly 1,500 employees in seven 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 strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums 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. Job DescriptionBWC'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: Manage Medicare medical subrogation claims, including reviewing Center for Medicare/Medicaid (CMS) conditional payment summaries, determining relatedness to workers' compensation injuries, processing payments, and preparing disputes or appeals. Strong communication skills, including professional written communication drafting persuasive disputes/appeals and formal correspondence that clearly establish claim payment disqualification, citing applicable policy (e.g., BWC policies), and organize supporting evidence (remits, checks, medical records) into comprehensive, professional packets. Track, update, and maintain case activity in CoreSuite Medicare Tracker, monitor Open Debt Reports, and follow up with Medicare contractors on errors, re-openings, or updates. Organizational and multitasking skills, including prioritizing work, tracking case actions, time management, and maintaining accurate documentation Why Work for the State of Ohio 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) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position. Qualifications3 courses or 9 mos. trg. or 9 mos. exp. in English composition or grammar; 3 courses or 9 mos. trg. or 9 mos. exp. in accounting, bookkeeping or general business mathematics; 3 courses or 9 mos. trg. or 9 mos. exp. in communication or public speaking or 9 mos. exp. involving contact with injured workers, employers, legislators, providers or their representatives & public; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or 12 mos. exp. as Workers' Compensation Claims Assistant, 16720, (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self-insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law). -Or 12 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations). Note: Classifications may require use of proficiency demonstration to determine minimum class qualifications for employment. -Or equivalent of Minimum Class Qualifications For Employment noted above. Job Skills: Claims Examination Major Worker Characteristics: Knowledge of: (1)Workers' Compensation policies & procedures & laws & regulations governing adjudication & management of medical claims*, (2)Ohio Revised Code*, (3)eligibility criteria & workers' compensation processing procedures*, (4) Medical Services & Medical Billing & Adjustments policies & standard operating procedures*, (5*) Medicare Secondary Payer Act* (5*6)oral & written business communication, (7)English grammar & spelling, (8)public relations, (9)principles of customer service, (10)addition, subtraction, multiplication, division, fractions, decimals & percentages, (11)standard business practices, (12)medical terminology*, (13)medical diagnosis coding*, (14)Industrial Commission processes*, (15)CAM edits & explanations of benefit*. Skill in: (1)operation of personal computer & peripherals (e.g. printer, fax, scanner, copier), (2)use of Microsoft Office products (e.g., Word, Access, Excel, Outlook), (3)use of BWC-specific software (e.g., Hyland OnBase, CoreSuite, CAM, OHIO.BWC.gov, COR,)*, (4)communication skills (e.g., listening, writing, reading, phone etiquette)*, (5)use of internet search engines & navigation*, (6)use of calculator*, (7)use of 10-key*. Ability to: (1) communicate (written or oral) professionally with injured workers, employers, MCOs, legislators, providers & their representatives & the public, (2)deal with many variables & determine specific action, (3)read & understand technical reference manuals (e.g., MCO policy reference guide), (4)define problems, collect data, establish facts & draw valid conclusions, (5)write clear, concise & professional correspondence & reports, (6) assess questions & provide appropriate referral or information, (7)develop good rapport with internal & external customers