The Workplace Safety and Insurance Board (WSIB) helps people overcome workplace injuries and illnesses and helps business owners make their workplaces safe and healthy. Our people are at the heart of what we do. Bring your enthusiasm and expertise to the WSIB, and we'll help you achieve your personal and professional goals through meaningful work, development opportunities and a culture of compassion, integrity and teamwork.
We are the WSIB. And we're here to help.
WSIB offices remain closed due to COVID-19. Our priority is the health and wellness of employees and the people of Ontario. As such, this position may involve working from home for all or part of the duration of this position.
Job Summary:
The Program Manager will be a proactive leader and instrumental in providing the Chief Officer/VP support in making key decisions for the Cluster/Division. Assist the Chief/VP through coordination and project management of Cluster/Division responsibilities, including the gathering of research and analytical information necessary to facilitate executive decisions and action.
Provide technical advice and expertise to the Chief Officer/VP, senior management and other internal stakeholders on business planning, risk identification, issues management and continuous improvement/best practices to support the cluster/division direction within the WSIB corporate plan.
Act as an entry-point for the Cluster/Division and maintain effective communication channels to enhance customer service and engagement.
About the job
Starting Salary: $56,085.59
WSIB offices remain closed due to COVID-19. Our priority is the health and wellness of employees and the people of Ontario. As such, this position may involve working from home for all or part of the duration of this position.
Hours of work are 9:15am to 5:15pm
Recruiting for unilingual and bilingual vacancies in the following office locations: Hamilton, London, Ottawa, Sudbury, Toronto & Windsor
Should you be successful in this competition, you will be placed in a pool of qualified candidates to be considered for current and future vacancies
Job Summary:
Render and communicate decisions with respect to various Health Care / Return To Work expenses and pre-approvals based on defined criteria and within prescribed policies and procedures. Action a variety of Health Care / Work Transition expenses using various WSIB systems.
Respond effectively to external and internal customer needs to facilitate health care decisions, educate and inform workers, Health Care and Work Transition service providers, worker representatives and employers of their rights and obligations relating to WSIB Health Care and Work Transition payment enquiries/billing issues, and their related policies, processes and guidelines.
Major Duties & Responsibilities
1. Render initial and ongoing health care entitlement decisions with respect to but not limited to treatment, orthotic and prosthetic items, clothing allowance, travel, and work transition expenses based on defined criteria and within prescribed policies and procedures. Identify and refer ongoing health care or claims entitlement issues to Work Transition Specialists, Nurse Consultants and/or Case Managers as required. Communicate Health Care benefits entitlement decisions including adverse or restrictive decisions, verbally and in writing, to appropriate parties.
2. Review and determine authorization to Health Care and Work Transition related expenses (ie, physiotherapy, chiropractic treatment, braces, supports and medical devices) for payment to workers and providers in accordance with applicable guidelines, policies, and procedures using various WSIB systems (such as PBAS, PowerTrak, Drug System, Imaging and CICs) by:
· Identifying, gathering, analyzing information within prescribed timeframes;
· Determining and authorizing a worker's entitlement to Health Care benefits such as physiotherapy and chiropractic treatments in active cases;
· Authorizing Health Care benefits to be processed to workers and providers and ensuring the amount of payment is correct for the appropriate time periods;
· Inputting and assessing bills for processing various types of Health Care and Work Transition expenses and applying appropriate explanation codes in order to process Health Care benefits.
· Authorizing initial and repeat clothing allowance benefits and creating and entering future clothing allowance payments for workers using PBAS predictive payment system; updating information to ensure worker payments are automatically processed;
· Verifying whether bills identified by PowerTrak as potential duplicates are actual duplicates;
· Correcting input errors using PowerTrak system;
· Determining whether previous Health Care/Work Transition entitlement has been previously granted;
· Identifying and referring potential fraudulent cases to Regulatory Services for action;
· Attempting to prevent or resolve disputes, handling requests for reconsideration and if appealed, arranging access and processing the objection.
3. Process simple and complex amendments relating to overpayment recoveries, cost transfer/cost removal in Health Care/Work Transition bills and overturned decision payments. Review/Investigate and amend payments or returned cheques from providers and workers in order to re-issue or recover benefits using the PowerTrak system.
· This includes creating bill and claim notes to explain details of an adjustment or corrected payment amount and informing Case Managers of action taken as required.
· Reviewing relevant sections in the claim file regarding Health Care benefits
· Calculating the amount of overpayment for each claim/provider;
· Initiating an overpayment recovery (i.e. how the overpayment will be recovered; creating an overpayment plan or request for a personal cheque to recover immediate costs);
4. Review, edit and resolve "electronic" payment exceptions that cannot be processed by PowerTrak's automated rules engine, within established timeframes and parameters by:
· Reviewing administrative irregularities against paper/imaged claim file and the PowerTrak system to resolve issues/problems which may include contacting provider and/or worker to clarify or obtain missing information;
· Referring "electronic" billings with respect to entitlement or clinical issues to the Service Delivery Teams (SDT) via work list, referrals, memos, and emails;
· Applying appropriate explanation codes to bills using PowerTrak to process approval, denial or reduction.
5. Assess and handle verbal/written requests from preferred and non-preferred providers for initial or ongoing worker Health Care medical devices or treatment to determine if these have been previously authorized or applicable within our guidelines. This is done by:
· Reviewing the claim file and worklist to create or update Utilization Rules (UR) for preauthorized treatments and render a decision;
· Verifying negotiated prices applied where a preferred relationship exists while ensuring preferred providers apply agreed upon discounts;
· Referring complex issues to SDTs.
6. Respond to and action general and account enquiries from providers, workers, employers, representatives and WSIB staff by:
· Answering queue driven calls as well as placing outbound calls in order to respond to general or specific enquiries related to Health Care benefits, work reintegration, appeals, serious injury and OD&SPB, or WSIB operational policies or redirecting clients/customers to appropriate area;
· Reviewing and resolving work transition expenses and matching against plans using Web Interface for transitional files;
· Reviewing payment history/claim file to identify and confirm missing information;
· Explaining Health Care policies, procedures and fees, dealing with priority correspondence and providing information and assistance, such as health care payment status, cheque amounts and cheque numbers, informing, educating and clarifying information on Explanation of Benefits Statements to providers and workers; and on the Accident Cost Statement to employers and SDTs;
· Submitting requests to have unregistered providers registered prior to payment to Provider Registration Clerks.
7. Provide assistance and support to the SDTs and other internal clients, when directed by:
· Updating PowerTrak based on information provided by SDTs in order to override global rules;
· Providing health care payment details to the Legal Services Branch in third party claims, as well as other insurers;
· Preparing requests for manual cheques and foreign drafts for Manager's approval and forwarding request to Treasury;
· Assigning and inputting appropriate Injury Classification Diagnostic Codes (ICD-9 codes) which can involve multiple fields in the PowerTrak system including reviewing initial diagnosis to identify the area of injury in order to process bills or as instructed by SDTs.
8. Perform other related duties as assigned or required.
· Compiling daily/weekly productivity statistics and providing summary to manager.
What you bring to the team
Job Requirements:
Education:
- High school completion plus additional specialized courses or certificate program up to one year in medical office administration.
Experience:
- One year prior in medical/health care related experience.
Additional Information:
As a precondition of employment, the WSIB will require a prospective candidate to undergo a criminal records name check prior to or at any time following hire.
To apply for this position, please submit your application by the closing date noted above.
We appreciate the interest of all candidates. Due to the volumes of applications we receive, we are only able to contact candidates that are selected to move forward in the recruitment process. The WSIB is an equal opportunity employer.
The WSIB is an equal opportunity employer and provides accommodation for job applicants in accordance with the Human Rights Code and the Accessibility for Ontarians with Disabilities Act. If you are an individual with a disability and you need accommodation in order to apply for this position, please contact talentacquisitioncentre@wsib.on.ca. If you are invited to participate in the assessment process, please provide your accommodation needs at that time. Please be advised that you may be required to provide medical documentation to the WSIB's Corporate Health Department so that appropriate accommodation can be provided to you throughout the recruitment process.
Employees of the WSIB have important ethical responsibilities, including the obligation to place the public interest above personal interests. Job applicants are therefore required to disclose any circumstance that could result in a real, potential or perceived conflict of interest. These may include: political activity, directorship or other outside employment and certain personal relationships (e.g. with existing WSIB employees, clients and/or stakeholders). Please contact TAC if you have any questions about conflict of interest obligations and/ or how to make a disclosure.
Privacy Statement
Personal information will be collected from your resume, application, cover letter and references under the authority of the Workplace Safety and Insurance Act, 1997 and will be used by the Talent Acquisition Centre and WSIB hiring parties to assess/validate your qualifications and/or determine if you meet the requirements of vacant positions and/or gather information relevant for recruitment purposes. If you have questions or concerns regarding the collection and use of your personal information, contact the WSIB Privacy Office, 200 Front Street West, Toronto, ON, M5V 3J1 or 416-344-5323 or 1-800-387-0750 extension 5323. Be advised that information related to application status will not be provided.