MCO Statistical Payment Program Manager (TMS)

Workers' Compensation

  • Franklin County, OH Columbus, OH
  • Permanent
  • Full-time
  • 13 days ago
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 Statistical Payment Program Manager will lead the management, statistical analyses, and processing of the contract payment to BWC’s 9 Managed Care Organizations.
  • This role includes compiling, reviewing, and stratifying 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 statistical cost and outcome 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.QualificationsTo 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.Preferred QualificationsMaster’s degree in health administration, public administration, business administration, mathematics or statistics.*** 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.

Workers' Compensation