Deputy Manager/Manager - Credit Cells

Role & responsibilities

Credit Cell Department Leadership :

Lead and manage the Credit Cell department, overseeing day-to-day operations, staff performance, and ensuring efficient claim processing.

Establish clear performance goals, KPIs, and targets for the Credit Cell team and track progress regularly

Documentation and Compliance :

Ensure checklist of each TPA/ Government institutions for claims are properly followed

Develop and maintain strong relationships with external insurance providers, TPAs, Government Institutions and internal hospital departments

Address and resolve complex issues between the hospital, insurance companies, and patients

Ensure all dispatches are timely processed with proper documentation to TPA/ Government institutions

Claim Management and Process Improvement:

Ensure all insurance policies, claims, and pre-authorization requests are accurately handled

Oversee the timely and accurate submission of insurance claims, ensuring compliance with hospital policies, insurance company requirements, and regulatory standards

Review claim denials, underpayments, and delayed payments, and implement corrective actions to reduce issues

Implement strategies to improve the approval rates of claims and streamline the claims submission process

Ensure all Deductions and rejections at the time of settlement are properly addressed

Financial Oversight and Revenue Optimization:

Monitor the TPA claims and reimbursement process to ensure the hospital receives timely and full payments from insurance companies

Track key metrics such as claim rejection rates, AR (Accounts Receivable) aging, and payment turnaround time to ensure revenue cycle efficiency

Work closely with the finance team to ensure that insurance claims are processed correctly and that payment discrepancies are addressed

Reporting & Documentation :

Prepare and present detailed reports on TPA activities, including insurance claims status, pending approvals, rejections, & payments to senior management.

Monitor key performance indicators (KPIs) such as claim approval rates, payment timelines, and patient satisfaction

Maintain accurate documentation for audits and compliance checks, and ensure all claims and payments are tracked and recorded properly

Dispute & Issue Resolution :

Training and Knowledge Management :

Collaboration with Other Departments:

Job Location: Jaipur