Columbus WC Medical Claims Specialist PN

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 reasonable accommodations related to disability pregnancy or religion pleasecontact the ADA mailbox.

BWC OCSEA Selection Rights:
This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.

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.

At the State of Ohio we take care of the team that cares for Ohioans. We provide a variety of quality competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits visit ourTotal Rewards website! Our benefits package includes:

• 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.

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 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.

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 Youll 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

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services activities programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

3 courses or 9 mos. trg. or 9 mos. English composition or grammar; 3 courses or 9 mos. trg. or 9 mos. accounting bookkeeping or general business mathematics; 3 courses or 9 mos. trg. or 9 mos. 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 COR)* (4)communication skills (e.g. listening writing reading phone etiquette)* (5)use of internet search engines & navigation* (6)se 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 (8)gather collate & classify information about data people or things (9)respond to sensitive inquiries from & contacts with injured workers employers health care professionals (10)multitask by utilizing good organizational skills & time management (11)make proper referrals (within agency & external sources) (12) work as a team (13)prioritize workload based on performance goals (14)interpret data warehouse reports*.

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39) and as outlined in the posting.

A Little About Us:
With roughly 1500 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.