MCO Additional Payment Program Manager (TMS) -
MCO Additional Payment Program Manager (TMS) -
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Salary Not Disclosed
1 Vacancy
Job Description
To Qualify You MustClearlyDemonstrate:
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 monthspractical experiencein health care field; 12 monthsexperiencein 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.
BWCs 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 BWCs 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 Youll Be Doing:
- Under the direction of the Director of the MCO Business Unit the MCO Administrative Payment Program Manager will lead the management and processing of the contract payment to BWCs 9 Managed Care Organizations.
- This role includes compiling and reviewing large amounts of data used in the calculation of the payment and managing contract payment appeals.
- The payment manager will work with the team to develop cost predictions used to negotiate contract terms and measure program outcomes.
- The payment manager will develop payment policies and operational controls for efficient and accurate payment methodologies.
The ideal candidate will be familiar with use of Microsoft Excel and statistical modeling tools. 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.
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 1500 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 societys 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 Ive 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.
Required Experience:
Manager
Employment Type
Full-Time
