Assistant General Manager Billing

Role & Responsibilities

• Audit and Compliance:

  Conduct detailed audits of medical claims and billing processes to ensure accuracy, compliance with TPA agreements, and adherence to regulatory guidelines (e.g., IRDA guidelines in India).

• Recovery and Reconciliation:

  Lead efforts to follow up on pending, short-settled, or denied claims. Oversee the reconciliation of TPA accounts with the finance department to maximize reimbursement and minimize revenue leakage.

• Process Management:

  Manage the end-to-end TPA process, from patient pre-authorization and admission to final claim submission and settlement. Identify and implement process improvements to enhance efficiency and reduce claim denials.

• Team Leadership:

  Lead, mentor, and motivate a team of TPA and recovery executives. Conduct training sessions for staff on medical terminology, coding updates (like ICD-10, CPT, HCPCS), and best practices.

• Liaison and Communication:

  Act as the primary point of contact between the hospital, TPAs, insurance companies, and corporate clients. Handle escalated queries and disputes from patients and insurers with professionalism.

• Reporting and Analysis:

  Prepare and present regular MIS reports and dashboards related to TPA collections, rejections, accounts receivable, and performance metrics to senior management.

• Contract Management:

  Review and ensure claims are settled in line with agreed-upon Memoranda of Understanding (MOUs) and tariff agreements with TPAs and insurance partners.

Preferred candidate profile

• Technical Knowledge:

  In-depth knowledge of TPA/insurance claim processes, pre-authorization, medical billing codes (ICD-10, CPT), and hospital information systems (HIS).

• Soft Skills:

• Strong analytical and problem-solving abilities.
• Excellent communication, negotiation, and interpersonal skills.
• Strong leadership and team management capabilities.
• Exceptional attention to detail and organizational skills.
• Ability to manage time-sensitive processes and work under pressure.

Contact@ 9771471971