Hospital Billing Manager

Job Title: Hospital Manager – Insurance & Package Billing Operations

Department: Administration / Billing & Revenue Cycle Management
Reports To: Hospital Administrator / CEO / Director – Operations
Experience: 5–10 years in hospital administration or revenue cycle management with TPA/insurance exposure
Education: Bachelor's/Master's degree in Hospital Administration, Healthcare Management, or related field

Job Summary:

We are seeking a detail-oriented and experienced Hospital Manager with a strong understanding of package billing, insurance, and TPA operations within the Indian healthcare ecosystem. The role involves managing and streamlining end-to-end package billing processes, ensuring compliance with government and private insurance providers, and maximizing revenue realization for the hospital.

Key Responsibilities:

1. Package Billing Management

• Oversee the end-to-end billing process for cashless and reimbursement packages, including Ayushman Bharat (PMJAY), CGHS, ECHS, state schemes, and corporate insurance packages.
• Ensure accurate mapping of treatment packages as per TPA/Insurance empanelment agreements.
• Monitor pre-authorisation, enhancement, and final billing processes.
• Validate documentation and clinical coding to ensure compliance with the package definition.

2. Insurance & TPA Coordination

• Liaise with all empanelled insurance companies, TPAs, and government health schemes.
• Submit necessary documentation for pre-authorization, follow-ups, discharge summaries, and post-treatment bills.
• Ensure timely submission of claims and reduce rejections/denials by improving documentation quality.
• Coordinate with medical, nursing, and billing teams for smooth processing of claims.

3. Revenue Cycle & Claims Management

• Supervise claim generation, submission, tracking, and reconciliation.
• Monitor outstanding dues and follow up for payments with insurers and TPAs.
• Analyze denial reasons and initiate corrective measures to prevent future rejections.
• Ensure TAT (Turnaround Time) adherence for discharge billing and claim submissions.

4. Compliance & Audit

• Ensure billing complies with IRDAI, NABH, and government regulatory norms.
• Prepare for internal/external audits of insurance and package billing.
• Maintain records and logs for transparency and reporting.

5. Reporting & MIS

• Generate daily, weekly, and monthly MIS reports for package utilization, claims submitted, payments received, and pending.
• Provide input for strategic pricing decisions and package negotiations.
• Present insights to management for revenue improvement.

6. Team Management & Training

• Lead and manage a team of billing executives and coordinators.
• Train staff on billing protocols, documentation standards, and system updates.
• Develop SOPs for package billing and insurance processing.

Key Skills & Competencies:

• In-depth knowledge of TPA operations, insurance billing, and healthcare packages in India.
• Understanding of billing code wise with insurer and TPAs'
• Familiarity with healthcare IT systems (HIS/ERP), e-filing portals, and TPA software.
• Strong communication and coordination skills with medical and non-medical teams.
• Good understanding of hospital finance, compliance, and revenue leakage control.
• Analytical skills with proficiency in Excel and MIS reporting.

Preferred Qualifications:

• Experience working in NABH-accredited hospitals.
• Exposure to state/central government health schemes (PMJAY, CGHS, etc.).
• Certification in Medical Billing/Coding (optional but preferred).

Salary & Benefits:

• Competitive salary [Specify Range] based on experience.
• Performance-based incentives.
• Health insurance and additional staff welfare benefits.

Job Types: Full-time, Permanent

Pay: Up to ₹45,000.00 per month

Work Location: In person