About this PositionThe 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.
Responsibilities & QualificationsTechnical Skills
- 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
Leadership & Interpersonal Skills
- 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
Professional Attributes
- 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
Required Qualifications
- Education: Bachelor's degree in Health Administration, Business, Finance, Healthcare Management, or a related field; or equivalent combination of education and relevant experience
- 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
Preferred Qualifications
- 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.
Texas Mutual Pay TransparencyThe base pay range is based on the market evaluation of the job and may include pay for multiple levels. Individual base pay within the range is determined by a variety of factors, including experience, performance, education, and demonstration of skills and competencies required for each role. Your recruiter can discuss the full value of our total compensation package with you, including our generous bonus plans and flex-hybrid work model.
Base Pay Range: $102,485.35 - $126,599.55 Per Year
Flex-Hybrid Work Environment:Texas Mutual’s flex-hybrid schedule allows you to bring your best self to work by working remotely and collaborating in the office based on business needs. All Texas Mutual employees are required to have Texas residency and travel to their designated office as needed.
Our Benefits:Annual performance bonus and 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 and two personal days each year
Day one health, Rx, vision and dental insurance
Life and disability insurance
Flexible spending account
Pet insurance and pet Rx discounts
Free on-site gym, fitness classes, and health and wellness resources
Free identity theft protection
Free student loan repayment and refinancing consultation
Professional development and tuition reimbursement
Employee referral bonus
Free onsite snacks
