ASSISTANT MANAGER - INSURANCE & BILLING

Job Description

Performs overall revenue management including: satisfying timely filing requirements and maximizing billing revenue and collections, and resolution of denied/rejected claims. Monitors reports to ensure clean claims submissions. Monitors monthly aging reports and conduct follow-up on unpaid claims and take appropriate action to correct and re-bill for reimbursement. Identifies, researches and resolves system issues through direct contact with software vendors. Provides technical expertise to ensure accurate billing including billing for new services and staying informed of regulatory, compliance, and best practices for billing. Develops, implements, and maintains revenue cycle standard operating procedures (SOPs). Performs regular audits of daily billing reports to identify coding and billing errors. Work with billing clerk and other billing staff to address; notify on-site management of problems and troubleshoot as needed. Monitors A/R aging and payment reports monthly to identify trends and underpayments; investigate causes and take appropriate steps toward resolution using professional judgment. Provides monthly updates of revenue cycle status including reports, metrics, and presentations. Works with CFO and Staff Accountant as needed to accomplish. Works closely with the Practice Management System vendor to identify and work to resolve systemic issues. Provides training as required to on-site staff regarding: billing and other revenue cycle related tasks, standard operating procedures (SOPs). With other members of the management team, develop continuous process and priorities for quality improvement to improve revenue cycle outcomes. Handle and be knowledgeable of all software utilized in the management of operations related revenue, including understanding of pertinent service contracts. Insurance: Oversees administration of medical services to Insurance and Corporate patients or/and customers of the Hospital. Liaises with insurance companies regarding eligibility, payments, reconciliation and other requirements. Reviews insurance claims to ensure accuracy as per agreement, prior to dispatch to respective insurance companies. Proactively reports critical issues to Management and submits monthly aging and other reports to line manager and Accounts. Designs, updates and implements policies, procedures and protocols to ensure efficiency and accuracy in insurance operations. Monitors insurance discounts, rejections and submits periodic reports to the Management for review. Ensures that the insurance schemes are up to date on the system. Attending and organizing the insurance presentation internally and externally. Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counseling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Preparing split bills/ Doctor charges etc. Handling all TPA Portals. Outstanding follow-up with TPA. Monthly Review report. To obtain and review referrals and authorizations for treatments. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies to pass or clear the Health Insurance claims. Job Type: Full-time Pay: ₹40,000.00 - ₹60,000.00 per month Benefits: Food provided Health insurance Leave encashment Provident Fund Schedule: Fixed shift Education: Bachelor's (Preferred) Experience: Insurance & Billing: 10 years (Preferred) total work: 10 years (Preferred) Work Location: In person