Job Description

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3/15/2026 (8:00 PM EDT)

26-01180

Medical Certification Specialist

Pay Grade 14

Salary

$3,600.84 - $4,861.14 Monthly

Employment Type

EXECUTIVE BRANCH | FULL TIME | ELIGIBLE FOR OVERTIME PAY | 18A | 37.5 HR/WK

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Hiring Agency

Education & Labor Cabinet | Department of Workers' Claims

Location

500 Mero Street, 3rd Floor

Frankfort, KY 40601 USA

Description

The Kentucky Education and Labor Cabinet advances education, workforce development, and economic opportunity across the Commonwealth. The Cabinet provides education and training programs, employment and reemployment services, unemployment insurance, and disability determination services to help Kentuckians gain skills, find work, and maintain economic stability. It partners with education providers, workforce boards, and employers to align training with labor market needs and oversees labor programs that promote fair and safe workplaces.

The Education and Labor Cabinet is seeking to fill Medical Certification Specialist position located within the Department of Workers’ Claims, Division of Specialist & Medical Services.

The preferred candidate for this position will demonstrate the ability to communicate clearly and concisely, and work cooperatively with a team, have a working knowledge of Microsoft Office products and a history of working with databases and reports.

Job Duties Include

• Coordinate the scheduling of University Evaluations (UE) to comply with KAR 342:315. Interpret orders from Administrative Law Judges (ALJ) to determine appropriate university physician to utilize, depending upon injury. Coordinate the distribution of reports to the provider, carrier, plaintiff attorney and defense attorney, ensuring they are received by all parties in a timely manner.
• Coordinate the dissemination of financial data found on Health Care Financing Administration (HCFA) 2552 as it relates to specific hospitals calculation for an assigned cost-to-charge ratio PER 803 KAR 25:091. Notify each hospital by letter of their ration. Ensure that job task is completed in a timely manner as established by the Medical Services Branch.
• Update spreadsheets for University Evaluations and cost-to-charge ratios for facilities. Coordinate, oversee, update and make notification concerning reports, summaries and statistical information for Branch Manager, Director, and Commissioner.
• Assist in the Managed Care area. Coordinate and review Managed Health Care System plans and network provider directories to ensure that the Plan provides evidence of established criteria and complies with KAR 25:110. Ensure that the provider directories have adequate coverage statewide, to ensure the injured worker has a choice in the physician that renders treatment for their workplace injury.
• Assist in the development and implementation of the Schedule of Fees for Physicians. Review drafts of the Schedule for accuracy; attend and participate in stakeholder meetings. Assist Branch Manager in reviewing Ground Rules for accuracy and corrections needed. Coordinate with the printer to ensure the Fee Schedule is ready to be distributed in a timely manner.
• Complete weekly, monthly and annual reports for University Evaluation for delivery to medical provider, Branch Manager, Director and Commissioner.

This position will have access to confidential and sensitive information. The successful candidate will be required to ensure the safeguarding and security of all confidential and sensitive information and will be required to complete trainings, sign acknowledgements, follow all policies and adhere to all statutes and requirements pertaining to the safeguarding and security of confidential and sensitive information while employed and after employment ends.

The Education and Labor Cabinet (ELC) participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the United States. ELC will only use E-Verify once you have accepted a job offer and completed the Form I-9.

For more information on E-Verify, or if you believe that ELC has violated its E-Verify responsibilities, please contact the Department of Homeland Security (DHS) at 999-897-7781 or .

Minimum Requirements

EDUCATION: Graduate of a college or university with a bachelor's degree.

EXPERIENCE, TRAINING, OR SKILLS: Three years of medical bill coding, medical insurance auditing, medical insurance adjusting, or Workers Compensation claims processing, or a related field.

Substitute EDUCATION for EXPERIENCE: NONE

Substitute EXPERIENCE for EDUCATION: Experience in medical bill coding, medical insurance auditing, or medical insurance adjusting, or Workers Compensation claims processing will substitute for the required education on a year-for-year basis..

SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.): NONE

Working Conditions

Incumbents working in this job title perform duties in an office setting.

Probationary Period

This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111.

If you have questions about this advertisement, please contact Shari Lafoe at Shari.Lafoe@ky.gov .

An Equal Opportunity Employer M/F/D

Job Tags

Full time, Work at office

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