Review Vacancy
AgencyWorkers' Compensation Board
TitleMedical Care Representative, WCB Item #3357
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $62697 to $78811 Annually
Appointment Type Contingent Permanent
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 Principal Medical Care Representative SG-25, 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 disputed medical bills 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. The incumbent must be thoroughly familiar with the correct application of the WCB medical, inpatient and outpatient hospital, ambulatory surgery, emergency room, podiatry, psychology and chiropractic fee schedules. 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 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;
• Review 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;
• Prepare a written summary of all issues in the dispute;
• Represent the Workers’ Compensation Board at desk and 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.
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#3357 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.