Technical Medical Specialist (PN 20082182) at Ohio Department of Administrative Services

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Full Time

Start Date

Immediate

Expiry Date

19 Feb, 26

Salary

0.0

Posted On

21 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Coding, Policy Development, Healthcare Administration, Quality Assurance, Statistical Analysis, Data Analysis, Performance Metrics, Training, Outreach, Medical Support Services, Cost Containment, Technical Writing, Healthcare Coverage, Reimbursement Techniques, Supervisory Principles

Industry

Government Administration

Description

***Chosen candidate will have the option to choose a permanent reporting location throughout the state. BWC offices are located in the following locations: Columbus, Cambridge, Canton, Cleveland, Springdale, Toledo, or Youngstown.*** 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: Drafts guidelines, policies and procedures related to artificial appliances, authorizes, and manages self-insured prosthetic & orthotics requests and multi-disciplinary evaluation (MDEs). Serves as the coordinator of the SI prosthetic and orthotic program and performs outreach, education, and training to vendors, providers, MCOs, and self-insured (SI) employers and (MDE) clinics. Serves as a coordinator to perform analysis of medical support operations functions, reviews and drafts revisions to policies and procedures related to BWC medical claim support services to assist with improving efficiency, timeliness, and outcomes of these services. Provides quality assurance audits or reviews to evaluate medical support services, including but not limited to nurse referral response, referrals to physician review, quality assurance of physician reviews and examinations, and catastrophic nurse advocate services to ensure efficient and consistent processes that improve clinical outcomes for injured workers; prepares reports summarizing quality assurance findings. Assists with the ongoing analysis and development of new performance metrics in support of quality assurance and process improvement; analyzes data and prepares reports for key performance measures; assists with monitoring trends to document improvements with consistency, timeliness, and outcomes for the nurse medical support functions. To Qualify, You Must Clearly Demonstrate: Required Experience and/or Education: Certified medical coder in current procedural terminology (CPT) hospital coding, or current ICD coding system AND 12 mos. exp in writing medical policies & procedures for medical provider or insurance company AND 12 mos. practical exp in health care field. Or completion of undergraduate program core coursework in pre-medicine, allied medical field, nursing or related field of study AND 12 mos. practical exp. in health care field AND 12 mos. exp. in writing medical policies & procedures for medical provider or insurance company. Or completion of graduate core program in health care administration AND 12 mos. exp. in medical policy development for medical provider or insurance company. 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.

Responsibilities

The Technical Medical Specialist will draft guidelines and manage requests related to prosthetics and orthotics while coordinating outreach and training for various stakeholders. Additionally, the role involves analyzing medical support operations and conducting quality assurance audits to improve clinical outcomes for injured workers.