The Director of TPA Services is accountable for the strategic planning, budgeting and end to end performance of the TPA services which are one component of the Management Services offering of Physicians Group of Texas (PGT). This position is responsible for oversight of claims adjudication, appeals, grievances, quality metrics, coordination of benefits, pre and post audit and over payment recovery activity. The position oversees training and development, policy development, and performance improvement for the department.
Job Title: Director, TPA Services
Clinic Location: PAOB
Job Type: Full Time
Required: Bachelor’s Degree in Finance, Accounting, Business Administration or related field
Preferred: Master’s Degree in Business, Health Care, Economics or related field
Required: 10 years of progressive management experience within a health plan, managed care organization, third-party administrator, or other healthcare entity to include benefits both fully insured and ASO and claims management.
Required: Valid Driver’s License
Preferred: Knowledge of software tools/solutions (clinical & code auditing, payment software)
Demonstrated understanding of physician practice operations and ways to improve information management specific to operating and financial improvement in a health care organization.
Knowledge of clinical data sets (CPT, HCPCS, ICD-10, etc.)
Demonstrated analytical and reporting skills.
Ability to work cross-functionally throughout the organization with leaders on support, product, finance, legal, underwriting and analytics
Proficiency in use of Microsoft excel
Knowledge of industry auditing solutions
Knowledge of Managed Care Reporting
Medicare Advantage experience
Knowledge of Utilization Review, Enrollment and Eligibility processes. Epic systems proficiency
Required: Excellent presentation and communication skills.
Working Environment: Office
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance