Supervisor Medical Operations

Texas Mutual Insurance Company•Austin, TX

4d•$102,485 - $126,600•Hybrid

About The Position

The Supervisor Medical Operations is responsible for overseeing inpatient facility bill audit operations, medical fee dispute resolution, medical and network performance, and developing cost containment strategies within the Texas workers' compensation system. This role requires a deep understanding of Texas regulatory requirements and serves as a subject matter expert in medical billing, fee dispute resolution, and vendor and compliance management. The ideal candidate is action-oriented, thrives in a dynamic environment, and demonstrates a proven ability to drive process improvement initiatives while 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
Bachelor's degree in Health Administration, Business, Finance, Healthcare Management, or a related field; or equivalent combination of education and relevant experience
Minimum of 5 years of experience in Texas workers' compensation, medical bill review, or managed care, with 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

Nice To Haves

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

Responsibilities

Overseeing inpatient facility bill audit operations
Medical fee dispute resolution
Medical and network performance
Developing cost containment strategies within the Texas workers' compensation system
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
Supervisory and team leadership
Negotiation in provider/facility contracting and rate discussions
Cross-functional collaboration with legal, public affairs, operations, and vendor partners
Presenting complex information to diverse audiences