Program Assistant State of Wisconsin

I m supporting an opportunity with the Wisconsin Department of Workforce Development for a Program Assistant 2 serving as a Worker s Compensation Specialist within the Health Cost Dispute unit. The position will support the review, investigation, documentation, and resolution of healthcare cost and treatment disputes involving injured workers.

Please review the details below and let me know if you are interested. If so, please share your updated resume, hourly rate expectations, availability, and confirmation that you can work onsite in Madison, Wisconsin, Monday through Friday from 7:45 AM to 4:30 PM.

• Client:
  Wisconsin Department of Workforce Development Worker s Compensation Division
• Position:
  Program Assistant 2 Worker s Compensation Specialist, Health Cost Disputes
• Location:
  
  201
  
  E. Washington Avenue, Madison, WI 53703
• Work Arrangement:
  Onsite
• Schedule:
  
  Monday through Friday, 7:45 AM to 4:30 PM
• Background Check:
  Wisconsin Department of Justice criminal arrest and conviction records check and completion of the DWD Background Check Form
• Security Requirement:
  Visible photo identification badge, which will be provided by the agency

The Worker s Compensation Specialist will support the Department s resolution of disputes concerning the reasonableness of medical fees, pharmacy fee schedules, and the necessity of treatment for medical services provided to workers with employment-related injuries. The selected candidate will review incoming healthcare cost disputes, determine whether disputes are connected to active worker s compensation claims, obtain information from involved parties, calculate appropriate payment amounts, prepare draft orders, and maintain accurate case records.

The position also requires frequent communication with injured employees, employers, insurance carriers, attorneys, healthcare providers, and other stakeholders regarding Wisconsin worker s compensation laws, procedures, and dispute-resolution processes.

• Review and analyze medical cost disputes for completeness, including justifications for medical charges and payment denials.
• Enter dispute information into the health cost dispute claim system, worker s compensation databases, and Excel tracking files.
• Determine whether each dispute is associated with an active worker s compensation claim.
• Associate disputes with existing claim files or initiate claims when no claim exists.
• Obtain additional information from employers, insurance carriers, employees, attorneys, and medical providers.
• Use computerized healthcare fee databases to identify certified fee information.
• Calculate payment amounts and prepare draft orders requiring carriers or employers to pay certified amounts.
• Apply applicable Wisconsin statutes, administrative rules, and Division guidelines.
• Research pharmacy fee schedule disputes and prepare final orders for review and signature.
• Apply the correct average wholesale drug prices using the Drug Topics Red Book.
• Address significant legal and medical issues raised by the parties.
• Document the primary factors considered when preparing decisions and orders.
• Provide technical support to other staff preparing less-complex pharmacy fee schedule dispute orders.

• Review submitted documentation to identify and clarify disputed issues.
• Contact involved parties by telephone or written correspondence to obtain additional information.
• Determine whether disputes involve the cause of injury, pre-existing conditions, or non-work-related injuries.
• Notify parties when a health cost dispute is placed on hold pending the resolution of related litigation.
• Evaluate whether submitted disputes meet established criteria for formal expert review.
• Compile case materials and submit necessity-of-treatment disputes to appropriate private experts for review and opinion.
• Track case progress and update actions in Excel and the claims information system.

• Respond to technical questions from injured workers, employers, insurance carriers, attorneys, and healthcare providers.
• Explain worker s compensation laws, administrative rules, procedures, and health cost dispute requirements.
• Conduct informal conferences and interviews with disputing parties.
• Review submitted information to determine the nature of disputes.
• Assist parties with understanding applicable claim and dispute-resolution procedures.
• Recommend policy or process improvements that could increase…