StateJobsNY

NY HELPNo

AgencyWorkers' Compensation Board

TitleMedical Care Representative, WCB Item #3073

Occupational CategoryHealth Care, Human/Social Services

Salary Grade19

Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)

Salary RangeFrom $59671 to $75785 Annually

Employment Type Full-Time

Appointment Type Contingent Permanent

Jurisdictional Class Competitive Class

Travel Percentage 0%

Workweek Mon-Fri

Hours Per Week 37.5

Workday

From 8:30 AM

To 4:30 PM

Flextime allowed? No

Mandatory overtime? No

Compressed workweek allowed? No

Telecommuting allowed? No

County Albany

Street Address Medical Directors Office/ Medical Guidelines

150 Broadway

City Menands

StateNY

Zip Code12204

Minimum Qualifications Candidates must be reachable on the appropriate Civil Service list,

- OR -

Only permanent Medical Care Representatives are eligible to transfer.

Duties Description Under the guidance of the Program Manager 3, SG-29, with direct supervision by the Supervising Medical Care Representative, SG-23, the Medical Care Representative, SG-19, is responsible for the medical review and preparation of files for the resolution of disputed health care provider bills 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 health care providers, carriers and arbitrators. The incumbent must be thoroughly familiar with the various WCB health care provider fee schedules and their correct application in determining fees payable to various provider types. The incumbent may also review coding changes and provide other assistance in the development and implementation of new or updated fee schedules, and to identify and assess selected provider billing patterns.


Specific duties of the Medical Care Representative include, but are not limited to, the following:
• 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;
• Review the arbitration request, associated billing 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;
• Prepare a written summary of all issues in the dispute;
• Represent the Workers’ Compensation Board at desk arbitration hearings;
• Respond to telephone inquiries regarding the correct application of WCB fee schedules and their associated processes, as well as arbitration hearing outcomes; and
• Promote communication between providers and payers to resolve disputes outside of the arbitration process by explaining WC law, fee schedules and applicable ground rules.
• Assist the Program Manager 3, SG-29, and the Supervising Medical Care Representative, SG-23, with additional projects as they arise.

Some positions may require additional credentials or a background check to verify your identity.

Name Recruitment Unit

Telephone 5184742685

Fax 518-486-6364

Email Address HRM@WCB.NY.GOV

Address

Street Human Resources Management- Room 133

328 State Street

City Schenectady

State NY

Zip Code 12305

Notes on ApplyingQualified 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 #3073 in the subject line of your email to ensure receipt of your application. (Please do not reference the Vacancy ID No.)