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State of Washington Classified Job Specification

MEDICAL TREATMENT ADJUDICATOR 4

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MEDICAL TREATMENT ADJUDICATOR 4
171H
Category: Financial Services

Definition

Assist the Supervisor of Medical Services in planning, developing and coordinating the implementation of medical management policies and procedures for Industrial Insurance claims.

Typical Work

Under the direction of the Supervisor of Medical Services, directs and supervises three Medical Treatment Adjudicator 3's who are responsible for the supervision of the Rehabilitation Section and clerical staff, training and skill enhancement programs for Medical Treatment Adjudicators 1 and 2, and revision of the Medical Aid Fee Schedule; 

Assists in developing and coordinating the implementation of medical management policies and procedures for industrial insurance claims working with the health care community, other state and federal agencies, and intra‑department divisions; provides consultation advice for planning, assigning, and supervising the review of requests from physicians, hospitals, clinics, chiropractors, osteopaths, and other health care providers regarding necessity for treatment as a result of the industrial injury; 

Initiates and answers correspondence and phone calls from health care providers and other interested parties outlining conditions under which health treatment can be allowed, interpreting the Industrial Insurance Act and Medical Aid Rules, and resolving mutual problems; 

Provides input into research, composition, maintenance, and revision of the Medical Aid Fee Schedule which is established in accordance with RCW 51.04.020 and RCW 51.04.030; provides input into the development and implementation of group and individual training programs for the medical treatment adjudication staff; 

Participates in and/or conducts individual and group meetings throughout the state with health care providers and their staffs, employer groups, and other interested parties to interpret and amplify department rules and policies, procedures regarding health care, and to resolve other problem areas in claim adjudication; 

Assists in maintaining liaison with the health care community and other state agencies to resolve mutual problems and exchange information; may act as a departmental representative on health care community and intra‑agency committees for special and pilot projects; 

Provides input for legislative committees and/or individual members of the Legislature as requested; 

Provides input into development and maintenance of the medical care information system; 

Acts as Supervisor of Medical Services in the supervisor's absence; Performs other related work as required.

Knowledge and Abilities

Knowledge of:  Worker's Compensation and Medical Aid Acts as they relate to medical treatment; departmental regulations and policies applying to industrial accidents; medical terms; anatomy; drugs; prosthetic devices; principles of effective supervision. 

Ability to: analyze medical and accidental facts and draw valid conclusions; interpret the intent of court and departmental orders; assist lower level adjudicators in making proper determinations regarding the validity of requests for treatment; write clear, concise, accurate, and informative correspondence; establish and maintain effective working relationships with health providers, injured workers, employers, and the public; speak before groups of professionals and laymen regarding Industrial Insurance and Medical Aid Laws.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Desirable Qualifications

A Bachelor's degree and three years of experience as a Medical Treatment Adjudicator, Disability Claims Adjudicator, medical administrator, insurance adjudicator, or closely allied field. 

Qualifying supervisory, managerial or consultative experience may be substituted, year for year, for a maximum of two years of experience. 

Additional qualifying experience may be substituted, year for year, for education. 

For Promotion Only: Two years as a Medical Treatment Adjudicator 2. One year as a Medical Treatment Adjudicator 3.

Class Specification History

Revised General revision and title change (formerly Medical Treatment Adjudicator 2) June 26, 1964
Revised minimum qualifications October 1, 1968
Revised definition, minimum qualifications and general revision October 12, 1979
Revised Class Code (Formerly 4785) March 11, 1983
New class code: (formerly 47860) effective July 1, 2007

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