Associate Manager - IP billing & Insurance (RCM)

Job Description

Role & responsibilities Verify Patient Insurance Coverage Confirm inpatient benefits, eligibility, and coverage details with insurance providers prior to or during admission. Obtain Pre-authorizations & Pre-certifications Secure necessary approvals from payers for inpatient services to ensure reimbursement. Generate and Submit Claims Prepare accurate claims using UB-04 forms, ensuring correct coding (ICD-10, CPT, HCPCS) and charge entry for inpatient services. Review and Interpret EOBs & Remittance Advice Analyze Explanation of Benefits (EOBs) and Remittance Advices to identify payment issues, denials, or short pays. Manage Claim Denials and Appeals Investigate denied or underpaid claims, correct billing issues, and submit appeals or reconsiderations to insurance carriers. Coordinate with Clinical and Administrative Teams Work with physicians, nurses, and case managers to ensure documentation accuracy and timely billing. Track and Follow Up on Outstanding Claims Monitor aging reports and follow up with payers to ensure timely payment of inpatient claims. Resolve Patient Billing Inquiries Address patient concerns regarding coverage, out-of-pocket costs, and payment options in a clear, professional manner. Ensure Regulatory Compliance Adhere to HIPAA, Medicare/Medicaid regulations, and payer-specific billing rules and guidelines. Maintain Accurate Billing Records and Reports Document claim activity, maintain billing logs, and generate reports for management or audits.Preferred candidate profile Qualification : B.COM (Any Graduate0 Experience : Minimum 5 year to a maximum of 10 years in Inpatient (IP) Billing & Insurance (RCM) within the hospital industry Job Type: Full-time Pay: ₹35,000.00 - ₹45,000.00 per month Benefits: Health insurance Leave encashment Provident Fund Schedule: Day shift Rotational shift Ability to commute/relocate: Bengaluru, Karnataka: Reliably commute or planning to relocate before starting work (Preferred) Application Question(s): Current CTC Expected CTC Notice Period Education: Bachelor's (Required) Experience: IP billing & Insurance (Hospital Industry): 4 years (Required) Language: English & Kannada (Required)