Claims Operations Manager

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Position

Req #: 10138
Category: DIRECTOR/MANAGEMENT LEVEL
Division: Finance
Employment Type: Full Time
Shift:
Hours:
Compensation Type: Salaried
Facility: JPOC 1400
Location: 1400 S. Main Street, Fort Worth, TX

Description

Description: The Manager, Medical Services Reimbursement performs a variety of administrative, clerical, physician relation and patient services duties necessary to maintain efficient flow of operations in the Medical Services Office. This position is responsible for the management of claim payments, customer service, issue resolution, and quality audit control functions for all JPS PSA (JPS Connection) contracts. Typical Duties:

  1. Supervises claim examiners, customer service, pre-certification, case managers and mailroom personnel directly appointed to the PSA contracts. Develops direct reports by defining roles/responsibilities and expectations, assigning and communicating performance and promoting professional growth and accountability. Communicates and aligns work priorities with the organizational vision, mission, values, and service standards.
  2. Maintains all policies and procedures within the department.
  3. Performs annual performance appraisals for employees.
  4. Maintains Issues Reporting System (log), statistical trending, and analysis, and any action plans and outcome evaluations as needed.
  5. Maintains integrity of all membership information into the Quick Link system.
  6. Maintains and coordinates a successful Performance Improvement Plan.
  7. Holds periodic meetings with all PSA customers to ensure adherence to contracts.
  8. Identifies and addresses training needs to ensure staff competency throughout the network in the area of compliance for both internal and external customers.
  9. Acts as a liaison between PSA and JPS regarding any billing and/or reimbursement issues to ensure follow through to completion and/or resolution.
  10. Performs other related job duties as assigned.

Qualifications

Qualifications:

    Required Education and Experience:

  • Bachelors Degree in Business, Accounting, Finance, or a related field from an accredited college or university.
  • 5 plus years of experience processing benefit and claims, revenue cycle, or similar transactions.
  • 2 plus years supervisory experience.
  • Required Licensure/Certification/Specialized Training:

  • Medical terminology and medical coding knowledge and/or training is required.
  • Preferred Education and Experience:

  • 10 plus years of experience processing benefit and claims, revenue cycle, or similar transactions.

About

JPS Health Network is a $950 million, tax-supported health care system for Tarrant County in North Texas. Licensed for 578 beds, the network includes an acute care hospital and more than 40 community-based clinics, including 19 school-based clinics. John Peter Smith Hospital is home to Tarrant County’s first and only Level 1 Trauma Center, its only psychiatric emergency services site and has the largest hospital-based family medicine residency program in the nation. Our network employs more than 6,500 people.

Acclaim is our multispecialty medical practice group. Acclaim has over 300 providers serving the JPS Health Network in specialties ranging from primary care to general surgery and trauma. The Acclaim group has been formed around a common set of incentives and expectations supporting the operational, financial and clinical performance
outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.

For more information, visit www.jpshealthnet.org .
To view all job vacancies, visit www.jobs.jpshealthnet.org/ or www.teamacclaim.org .
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