We’re excited you’re considering joining a great place to work!
Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer. 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.
About this 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.
Responsibilities & Qualifications
Technical 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 Transparency
The 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…