Note: For questions about the job posting, please contact the agency that posted this position by using the contact information provided on the "Contact" tab for the position.
Duties Description Under the direct supervision of the Supervising Medical Care Representative, SG-23, the Medical Care Representative, SG-19, will be responsible for the medical review and preparation of files for disputed medical bill resolution via the WCB arbitration process. The incumbent must be knowledgeable of NYS Workers’ Compensation law, rules and regulations and appropriately represent the Workers’ Compensation Board while interacting with healthcare providers, carriers, and arbitrators. Specific duties of the Medical Care Representative include, but are not limited to: Following review of the HP-1 arbitration request by the SG-14 WC Examiner and final approval by SG-18 Senior WC Examiner, perform a comprehensive medical review of billing/reporting codes and supporting documentation to ensure that the services billed are appropriate for the services rendered; reviewing the arbitration request, associated bills and documentation to ensure the applicable fee schedule amount in dispute is based on the correct interpretation of the Workers’ Compensation Board Fee Schedules and associated Ground Rules and Regulations; preparing a written summary of all issues in the dispute; representing the Workers’ Compensation Board at desk and panel arbitration hearings; and promoting communication between providers and payers to resolve disputes outside of the arbitration process by explaining WC Law, fee schedules and applicable Ground Rules.
Additional Comments Qualified candidates should send a letter of interest and resume which lists your actual Civil Service title, salary grade and specific verifiable information as to how you meet the minimum qualifications to be eligible to apply for this position. Please send your application to HRM@WCB.ny.gov (email applications are preferred). It is important that you reference the WCB Item #4271 in the subject line of your email to ensure receipt of your application. (Please do not reference the Vacancy ID No.)
Some positions may require additional credentials or a background check to verify your identity.