Tyler & Company is pleased to announce we have been retained by JPS Health Network in Fort Worth, TX to recruit a Director, Medical Services Reimbursement (physician claims).
JPS Health Network is a $950 million, tax-supported health care system for Tarrant County in North Texas. This award-winning network is anchored by John Peter Smith Hospital, a 573-bed acute care facility in Fort Worth. JPS has the county’s only Level 1 trauma center and psychiatric emergency services site. JPS is also a certified chest pain center, Certified Primary Stroke Center and an Accredited American College of Surgery Cancer Center. JPS has a Level lll Neonatal Intensive Care Center (NICU). JPS received the Modern Healthcare Best Places to Work 2017 designation, placing it among the top 150 healthcare companies in the nation. JPS is the only public entity in Texas included on the list , one of the most coveted honors in the industry. JPS was also named the best hospital in the United States by Washington Monthly magazine in July 2020 (visit: https://washingtonmonthly.com/2020-hospital-guide/honor-roll).
JPS Health Network also operates 14 nationally recognized medical home clinics throughout Tarrant County, strategically located to meet the needs of the communities it serves.
JPS is a teaching hospital, dedicated to training the physicians and health care workers of tomorrow. It sponsors 17 residency and fellowship programs, including the largest hospital-based family medicine residency in the country.
The director of medical services reimbursement is responsible for directing and leading the daily operations for professional and out-of-JPS Network provider claims and prior authorization requirements related to JPS Connection members and the approved uninsured patients covered services. Additional responsibilities include direct oversight to daily, weekly and monthly reporting of claims and payment activity, relationship management with physicians and other professional providers relating to contract management, customer service and claims’ issue resolution. The director implements policies and procedures that guide or support service levels, assesses and improves department performance, and ensures orientation and continuing education of departmental staff.
Duties and essential job functions:
- Directs and provides oversight to the functions, operations and reporting for the department.
- Acts as the liaison for provider relations to the contracted providers. Provides education, solutions and resolutions.
- Leads the overall projects, goal setting and action plans applicable to the success of the department.
- Directs and maintains the metrics and key performance indicators for the department’s performance.
- Manages claims examiners, case managers, system analyst, provider relations and clerical staff.
- Responsible for all policies and procedures within the department.
- Performs annual performance appraisals for employees.
- Responsible for statistical trending, analysis, action plans and outcome evaluations as required.
- Manages the integrity of all membership information into the Quicklink system.
- Responsible for the coordination and implementation of a successful performance improvement plan.
- Conducts periodic meetings with all professional and provider customers to ensure adherence to contracts.
- Identifies and addresses training needs to ensure staff competency throughout the network in compliance for both internal and external customers.
- Liaison between professional and provider contracted customers and JPS regarding any claims and/or reimbursement issues to ensure follow through to completion and/or resolution.
- Performs other job-related duties as assigned.
The successful candidate MUST have:
- Bachelor’s degree in business, accounting, finance or a related field from an accredited college or university.
- 10 plus years of experience processing medical claims and benefits, revenue cycle, health care finance operations or similar service environments.
- Five plus years of management experience.
Required licensure/certification/specialized training:
- Medical terminology and medical coding knowledge and/or training.
Preferred education and experience:
- Master’s degree in business, accounting, finance or a related field from an accredited college or university.
- Medical billing specialist training and experience.
*A strong compensation package, including executive benefits and relocation assistance, will be offered.
Job Type: Full-time
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Parental leave
- Professional development assistance
- Referral program
- Relocation assistance
- Retirement plan
- Tuition reimbursement
- Vision insurance
Interviews will be conducted via phone and video. Although this role will be onsite, there is flexibility regarding relocation timing due to COVID safety protocols and concerns.
- management : 5 years (Required)
- medical terminology or coding : 3 years (Preferred)
- medical claims : 10 years (Required)