Medical Office Billing Manager (Hospital)

Key Roles & Responsibilities:

1. Credit Billing Management

• Oversee the end-to-end credit billing cycle for patients under ECHS, CGHS, ESI, Ayushman Bharat, and various TPAs.
• Ensure timely generation, validation, and submission of bills as per the guidelines of each empanelled scheme.
• Coordinate with internal departments (nursing, pharmacy, diagnostics, etc.) to gather and verify documentation required for billing.

2. Scheme Compliance & Documentation

• Stay updated with latest circulars, pricing, coding changes, and guidelines issued by ECHS, CGHS, ESI, Ayushman Bharat, and TPAs.
• Ensure that billing is in strict adherence to the respective scheme's norms and rates.
• Maintain complete, accurate documentation for each case to avoid claim rejections or delays.

3. Coordination with Empanelled Agencies

• Act as the liaison between the hospital and the nodal officers/representatives of ECHS, CGHS, ESI, Ayushman, and TPAs.
• Handle queries, clarifications, and re-submissions of bills as required.
• Attend audits and verification processes conducted by third parties or government agencies.

4. Claim Management

• Ensure proper scrutiny and audit of all documents before claim submission.
• Track the status of submitted claims, follow up for pending approvals or payments, and resolve discrepancies.
• Maintain claim records, aging reports, and denial logs.

5. Patient & Internal Coordination

• Assist the admission desk in verifying eligibility of patients under respective government or insurance schemes.
• Educate patients and their families about the coverage, approvals, and financial responsibilities.
• Coordinate with treating consultants for pre-authorization and final approval documentation.

6. Reporting & MIS

• Generate daily, weekly, and monthly reports on:
• Pending claims
• Payments received
• Rejected/denied claims with reasons
• Department-wise credit billing status
• Analyse trends in rejections and suggest process improvements.

7. Audits & Internal Controls

• Prepare for and assist in external audits by TPAs, insurance companies, or government agencies.
• Implement internal control measures to ensure accuracy in billing and documentation.

8. Team Management

• Supervise a team of credit executives and billing coordinators.
• Allocate responsibilities, monitor performance, and provide training on billing procedures and updates to policies.
• Foster a culture of accountability and service excellence.

Qualifications & Experience:

• BAMS/MBBS, Graduate or Postgraduate in Hospital Administration, or Healthcare Management.
• Minimum 5-7 years of experience in healthcare billing, especially credit/ TPA/ Government scheme billing.

Familiarity with hospital billing software (HIS), TPA portals, and e-claim platforms like BPA/NHA portals.

Job Type: Full-time

Pay: ₹50,000.00 - ₹65,000.00 per month

Benefits:

• Paid sick time
• Provident Fund

Work Location: In person