Workers’ Compensation Manager
Summary of Position
FAIR Health assists workers’ compensation agencies in meeting their goals by supporting analysis, updating and development of fee schedules. Existing fee schedules may be updated to incorporate new procedures utilized in workers’ compensation programs, reflect changes in coding practices and compensation trends. To facilitate injured workers’ access to healthcare providers, FAIR Health provides support to create consensus among diverse stakeholders and reflect the needs and characteristics of the state jurisdictions.
The Workers’ Compensation Manager (“WCM”) will be responsible for working with these agencies to help them evaluate information to meet their needs. Responsibilities include responding to RFPs, supporting the development of policy through data and knowledge of other state fee schedules, developing payment guidelines and rate recommendations, meeting with state officials, presenting information and collecting feedback at stakeholder meetings and developing comparative analytics based on state data, CMS fee schedules, private health insurance cost information and other state fee schedules. The development of rates, updating payment guidelines, creation of schedules, formatting, QA and website storefront maintenance are the responsibility of the WCM.
- Works with states to understand their workers’ compensation fee schedule requirements
- Meets with state workers’ compensation officials at conferences
- Responds to Requests for Proposal
- Manages the information gathering process with state agency clients
- Meets with state officials to formulate approach to fee schedule development
- Provides consultative support to state officials
- Ongoing communication with workers’ compensation officials (pre and post contract)
- Development of comparative analyses
- Direct data analyst activities which may include recreating current fee schedules, modeling proposed fee schedules with alternative methodologies, and preparing communications back to the state officials
- Reviewing and proposing alternatives to maintain budget neutrality of the fee schedule, when applicable
- Develop recommendations on structure and cost of workers’ compensation fees
- Synthesize and package clinical research, for presentation to state officials
- Development of fee schedule rate tables and payment guidelines
- Oversee detailed editing and QA on the fee schedules
- Participation in stakeholder meetings, including presentations of proposed changes
- Fee schedule management and distribution
- Work with IT areas to maintain and enhance online ordering and payment capabilities
- Assist agency staff with questions relating to the fee schedule
- Manage annual maintenance and updates
- Support business development efforts
- Monitors and tracks state workers’ compensation program legislation and trends
Knowledge and Skill Requirements
- Bachelor’s degree in business administration, healthcare, labor relations or a relevant field
- Medical dental billing coding and clinical knowledge to support fee schedule development
- A minimum of 5 years’ proven experience in a either a state workers’ compensation agency working with fee schedules, consulting or industry practitioner role
- Strong knowledge of workers’ compensation regulations, legislation and processes
- Client facing skills
- Ability to develop client presentations based on clinical research and data analysis
- Outstanding verbal and written communication skills.
- Solid analytical, problem-solving and team management abilities.
Interested candidates should submit their resume to email@example.com. Please include “WCM” and your last name in the subject line.
FAIR Health, Inc. is an equal opportunity employer and an e-verify participant.