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About the Role
The Supervisor Medical Operations oversees inpatient facility bill audit operations, medical fee dispute resolution, medical and network performance, and develops cost containment strategies within the Texas workers' compensation system. This role requires expertise in Texas regulatory requirements, medical billing, fee dispute resolution, and vendor/compliance management, driving process improvements in a dynamic environment.
Responsibilities
- Overseeing inpatient facility bill audit operations
- Managing medical fee dispute resolution
- Monitoring medical and network performance
- Developing cost containment strategies
- Serving as a subject matter expert in medical billing, fee dispute resolution, and vendor and compliance management
- Driving process improvement initiatives
- Navigating ambiguity with sound judgment
Requirements
- Strong command of Texas Workers' Compensation statutes, TAC Title 28, and TDI-DWC payment policies
- Proficiency in CMS billing guidelines, medical coding (CPT, ICD-10, DRG, CMG, revenue codes), and UB-04/HCFA-1500 claim forms
- Advanced data analysis skills, with the ability to interpret complex datasets and translate findings into actionable recommendations
- Strong supervisory and team leadership abilities with a track record of developing high-performing teams
- Excellent negotiation skills with experience in provider/facility contracting and rate discussions
- Effective cross-functional collaboration skills with the ability to build relationships across legal, public affairs, operations, and vendor partners
- Clear and concise verbal and written communication skills, including the ability to present complex information to diverse audiences
- Action-oriented with a strong sense of urgency and the ability to drive results in a fast-paced environment
- Comfortable operating in ambiguous or evolving situations, demonstrating adaptability and sound decision-making
- Strong analytical and critical thinking skills with a solutions-focused mindset
- Proactive approach to continuous improvement, consistently seeking ways to enhance quality and reduce costs
- Minimum of 5 years of experience in Texas workers' compensation, medical bill review, or managed care
- At least 2 years in a supervisory or lead capacity
- Demonstrated expertise in TDI-DWC rules and regulations, CMS billing guidelines, and Texas workers' compensation medical fee guidelines
- Experience working with managed care organizations, TPAs, insurance carriers, or workers' compensation claims management environments
- Familiarity with workers' compensation utilization review and medical management processes
- Medical bill coding and audit knowledge
Skills
- Texas Workers' Compensation statutes
- CMS billing guidelines
- Medical coding (CPT, ICD-10, DRG, CMG, revenue codes)
- UB-04/HCFA-1500 claim forms
- Data analysis
- Team leadership
- Negotiation
- Provider/facility contracting
- Cross-functional collaboration
- Verbal communication
- Written communication
- Analytical skills
- Critical thinking
- Process improvement
Location
- Texas residency required
- Travel to designated office as needed
Work Type
- Flex-Hybrid Work Environment
Experience Level
- Minimum of 5 years of experience in Texas workers' compensation, medical bill review, or managed care
- At least 2 years in a supervisory or lead capacity
Education Level
- Bachelor's degree in Health Administration, Business, Finance, Healthcare Management, or a related field
- Equivalent combination of education and relevant experience
Salary/Compensations
- $102,485.35 - $126,599.55 Per Year
Benefits
- Annual performance bonus
- Merit-based pay increase
- Lifestyle Savings Account ($1,000 per year)
- Automatic 4% employer contribution to retirement plan
- 401k plan with 100% employer match up to 6%
- Student loan repayment matching in 401k plan
- Three weeks’ time off for vacation
- Nine paid holidays
- Two personal days
- Day one health, Rx, vision and dental insurance
- Life and disability insurance
- Flexible spending account
- Pet insurance
- Pet Rx discounts
- Free on-site gym
- Fitness classes
- Health and wellness resources
- Free identity theft protection
- Free student loan repayment and refinancing consultation
- Professional development
- Tuition reimbursement
- Employee referral bonus
- Free onsite snacks
About the Company
- Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect.
Equal Opportunity
- All qualified applicants are encouraged to apply and will receive consideration for employment without regard to age, race, color, national origin, religion, sex, gender identity, sexual orientation, genetic information, veteran status, or any other basis protected by local, state, or federal law.