Manager, Operations - Workers’ Compensation & Private Insurance

Job Description

Manages the daily administrative operations of a multi-physician, single/multiple practice (s) for a division or program. Coordinates administrative functions, plans and supports development of the site/joint division programs and all related areas. Manages all personnel, and maintains accurate and current files on all department budgets, capital equipment requests and programs related to operational issues.

Job Responsibility

1.Provides leadership to Operations team members and supervisors by communicating and guiding toward achieving department objectives.
2.Develops, communicates, and builds consensus for goals in alignment with the health system.
3.Coordinates administrative functions, plans and supports program development of the Department/Division; coordinates activities including growth objectives, space allocation, procurement of technological equipment, data planning, developing goals and objectives, capital requirements and desired outcomes of programs; serves as a liaison with Administration in planning, developing, implementing and evaluating operations; reviews comprehensiveness of programs on an ongoing basis and develops strategies for program adaptation to market changes; prepares reports and documents for Certificate Of Need (CON) applications; plans and coordinates construction projects.
4.Monitors program components relative to criteria by regulatory agencies; collaborates with the Research Institute to oversee Research operations; manages department/division in a fiscally responsible manner; assists in the preparation and monitoring of annual budgets - operational, personnel and capital.
5.Supports or may assist with key functions including, but not limited to, scheduling, insurance verification, co-pay collection, charge capture and referral management; understands the department/division’s fiscal responsibility in supporting research initiatives; manages daily operations and all non-clinical personnel in the division and all related areas; hires, trains, disciplines and supervises staff; evaluates performance and ensures efficiency in their roles; completes appraisals on a timely basis.
6.Oversees scheduling (vacation, holidays) and ensures adequate coverage at all times; performs related personnel functions; ensures staff members understand their roles and responsibilities; supports continued growth of staff and offers opportunities for advancement; assists in developing and maintaining objectives, policies and procedures to ensure the efficient operation of the department/division; strives to streamline operations and effectively apply new concepts and techniques for positive outcomes; identifies and implements technology to improve operations.
7.Assigns work and sees that it is carried out correctly and efficiently; identifies and implements technology to improve operations; maintains accurate and current files on all department budgets, capital equipment request and programs related to operational issues; acts as a liaison between attending physicians, patients, visitor's guests and staff; demonstrates ability to answer any questions that might arise when dealing with patients, physicians, or any matters regarding the department/division/physician office.
8.Coordinates and oversees the resources of multiple administrative disciplines/functions; coordinates efforts to prioritize needs of programs across departmental lines; collaborates with administrative leadership, chairs, physicians and other clinical personnel to develop, implement and oversee clinical programs; participates in monitoring and evaluating a program's inception and performance and routinely monitors performance per volumes, referrals and trends.
9.Optimize billing practices and collection of Part B revenues; coordinates physician schedules pertaining to division services; keeps abreast of all billing, coding and reimbursement related issues as they apply to the division and facilitates staff education in regard to these changes; structures the appropriate flow of data to ensure timely and appropriate management of clinical and financial issues, which may comprise patient care in the department.
10.Establishes and maintains a working relationship with the physician staff with respect to their compliance and performance related to billing, coding and regulatory agency standards; ensures the continual efficient and compliant operational performance of the department/division; ensures compliance with all rules and regulations and makes certain these are properly and completely addressed in Policy and Procedure Manual.
11.Reviews all changes in various regulatory agency standards and/or public health law and ensure that these are represented in the Policy and Procedure Manuals (after appropriate review with clinical and/or administrative personnel); ensures department/division staff adheres to the health system Corporate Compliance Program, HIPAA regulations and all other regulatory standards; identifies quality benchmarks utilizing regional and national data to monitor programmatic quality and identify opportunities for improvement.
12.Performs related duties as required.
13.All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.

Job Qualification

Bachelor's Degree required, or equivalent combination of education and related experience.
6-8 years of relevant experience and 2-5 years of leadership / management experience, required.

Additional Details: Manager, Workers’ Compensation & Private Insurance

• Oversee daily authorization operations for WC and private insurance, including MRI, neurology, pain management, viscosupplement injections, DME, medications, physical therapy, and surgery.
• Ensure timely outreach and follow‑up on all outside requests to reduce pendings and denials.
• Manage workers' compensation workflows, including documentation accuracy and carrier communication.
• Lead and develop supervisors and staff; maintain updated workflows, training materials, and performance expectations.
• Manage phone operations across both departments to ensure calls are monitored, handled appropriately, and meet service standards.
• Review and approve timecards, monitor productivity, and ensure daily work is completed accurately and on time.
• Collaborate with MRI centers, office staff, billing, collections, credentialing, and compliance to streamline processes and resolve workflow issues.
• Ensure consistent and compassionate patient care across both Workers’ Compensation and private authorization teams, promoting clear communication, timely updates, and a positive patient experience.
• Ensure compliance with payer guidelines, Workers’ Compensation regulations, and HIPAA requirements for both Workers’ Compensation and private insurance.

*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).