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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00201233 |
Description Activated On: 10/2/2025 3:08:17 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. Assists the Bureau of Workers’ Compensation Medical Cost Containment Chief in the management of the division’s programs; supervises clerical staff who review and process medical treatment documentation; monitors division contractors; and tracks legislative changes, case law, and trends in medical cost containment practices and recommends changes to division policies and procedures. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. Assists the Division Chief in the management of the Division’s programs: Medical Fee (MF) Schedules and Review, Utilization Review (UR), Impairment Rating Evaluation (IRE), and Medical Accessibility Study (MAS). Medical Fee Schedules and Review (selected duties): Serves as the primary liaison between the PA WC Chargemaster and Fee Schedule contractor, the Bureau, the Department, Part A Providers, submitting healthcare providers and professionals to ensure uncomplicated, seamless update processes, and facilitate timely and correct payment transactions between insurance carriers and health care providers. Identifies and advises leadership on content, format, and communication venues for information appropriate to disseminate throughout the community. Reviews federal proposed rules and updates and make recommendations to BWC leadership for how the changes may impact the fee schedule. Handles all verbal and written requests, provider submissions, and correspondences for Medical Fee Schedules; provides requesting parties with a detailed understanding of the BWC Fee Schedules; determines impact of jurisdiction on both in and out of state providers; analyzes requesting parties’ needs, organizational structures and business roles, and billing practices in order to determine which Fee Schedules apply; and advises stakeholders of the necessary information for obtaining the correct Fee Schedules and/or submitting data to providers, vendors, and/or BWC as appropriate. Impairment Rating Evaluation (selected duties): Acts as the Bureau’s representative and primary liaison for the division’s IRE process, oversight, and operations management. Reviews and approves IRE physician applications by determining that the physician meets regulatory criteria. Annually reviews all IRE physicians. Analyzes the IRE physician response rates to determine if access to IRE Physicians based on either location and/or approved American Medical Association Guides to the Evaluation of Permanent Impairment Edition is compromised and notifies the division chief of conclusions. Handles inquiries and communications regarding IRE physicians; investigates and responds to complaints about IRE physicians. Identifies and submits IRE related changes monthly to the Department press office. Researches, analyzes, interprets, assesses impact, and makes policy recommendations based on legislative changes and Commonwealth Court decisions affecting IRE. Medical Accessibility Study (selected duties): Serves as the primary liaison between the MAS contractor, the Bureau, and the Department; identifies and advises leadership on content, format, and communication venues for information appropriate to disseminate throughout the PA WC community; collects and reviews monthly vendor progress reports; and notifies the division chief of any identified areas of apparent noncompliance with the vendor’s contract. Coordinates and monitors the selection of outside experts to conduct medical accessibility studies. Schedules and leads the annual meeting with contractor and reoccurring status meetings throughout the year. Works with contractor to get upcoming surveys approved through Bureau Director. Obtains claimant, insurer, and healthcare provider reports for survey from the Department’s statisticians and send to contractor. Reviews contractor’s draft reports for quality and comprehensiveness, edits as appropriate before submitting to division chief and Bureau Director for final review. Coordinates launch with press office. Summarizes and analyzes the results of studies and make recommendations where appropriate for remedial medical fee allowance. Meets with division chief and Bureau Director to determine what initiatives will be launched in response to MAS. Develops a roll out plan for the initiatives that will be launched and executes the plan. Performs full range of supervisor duties over clerical staff to ensure adherence to provisions of the PA Workers' Compensation Act, specifically pertaining to Medical Cost Containment. Develops cross-training programs to support division staff; researches and produces written procedures and practices to be utilized in the cross-training of Department, Bureau, and Division staff as needed; develops operational based definitions of clerical roles for the purpose of assuring all clerical duties and tasks required for production of URs, IREs, and MFs are addressed. Collects, studies, interprets, analyzes, and summarizes information and data to identify issues and or changes needed arising out of new legislation or case law and develops solutions to improve the overall divisional operations and to support statutory obligations as necessary; prepares recommendations and justifications for changes in the Division’s policies, procedures, and processes and develops strategies to implement changes. Collaborates with the division chief to draft and update the division’s policies and procedures resulting from federal and state legislation or regulations, such as changes in regulations or guidance from the U.S. Centers for Medicare & Medicaid Services (CMS) resulting from the Inflation Reduction Act. Prepares statistical reports, as requested, such as responses to WC Research Institute (WCRI) surveys (usually five to six per year). Collaborates and works closely with the Division’s Health Care Informatics Specialist on matters that may impact any of the Division’s program areas related to WCAIS workflows and/or processes. Acts as the backup for the Division’s Health Care Informatics Specialist. Reviews incoming correspondence to the Division; drafts responses and apprises the division chief of trends suggesting a need for further investigation; organizes correspondence, ensures all inquiries have received a response, and maintains a variety of filing systems for the division, ensuring these files remain current and undergo archival maintenance compliant with the Department’s record retention policies. Performs public contact work in gathering information, resolving complaints, engendering support, and providing procedural and policy information to PA WC customers and stakeholders, such as healthcare providers, attorneys, employers, insurers, self-insured employers, Utilization Review Organizations, and contracted vendors, etc. Researches professional materials necessary to support operations; gathers input from staff and utilizes this information to determine supply and information resource needs; manages procurement of supplies and yearly periodical subscriptions for the Division; makes recommendations regarding operational changes aimed at reducing supply consumption/costs. Contributes to identifying the need for, and coordinates efforts for, special projects such as mass mailings; blast email notifications, seminars, external stakeholder committee meetings, speaking engagements, and/or training sessions for the Division’s stakeholders. Performs various other related tasks and duties as assigned. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. Regular duties and special assignments are received through general instructions or through his/her own initiative and are performed with considerable independence and conferring with the Division Chief and others in matters involving unusual or sensitive issues. Makes day to day decisions and solves problems or challenges with minimal oversight. Assesses contractors’ activities to determine whether contracts and/or contractors are out of compliance with federal and/or state requirements, the appropriate corrective action is taken, and/or whether referral to the bureau management or legal counsel is indicated. Determines clerical staff’s work priorities, sets performance standards and goals, evaluates work performance, decides if discipline is necessary, interviews and selects candidates for vacancies, approves/disapproves leave requests, identifies and determines training needs. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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