Senior Hospital Billing Manager – Cash Billing, Insurance Billing & Insurance Empanelment
Department: Cash & Insurance Billing
Designation: Senior Hospital Billing Manager
Location: Hyderabad
Industry: Healthcare / Hospital
Reporting To: Hospital Operations Head / General Manager / Management
Experience: 5–8 years in hospital billing, insurance billing, and empanelment, preferably with managerial experience.
1. Job Summary
The Senior Hospital Billing Manager is responsible for overseeing the complete hospital billing operations, including cash billing, insurance billing, corporate billing, TPA coordination, and insurance empanelment. The role involves ensuring accurate billing, timely claim submission, effective revenue management, denial reduction, and compliance with hospital policies and insurance guidelines.
The position requires strong knowledge of hospital billing software, insurance processes, cash collection, claim settlement, and coordination with clinical, finance, front office, and insurance departments.
2. Key ResponsibilitiesA. Cash Billing Management
- Supervise all cash billing activities for OPD, IPD, emergency, diagnostics, pharmacy, and other hospital services.
- Ensure accurate billing of consultations, procedures, investigations, surgeries, room charges, and other hospital services.
- Monitor daily cash collections, card payments, UPI transactions, and other payment modes.
- Ensure proper reconciliation of daily collections with billing reports and finance records.
- Monitor bill cancellations, refunds, discounts, concessions, and credit notes in accordance with hospital policies.
- Ensure all discounts and concessions are approved by authorized personnel.
- Monitor pending bills, outstanding payments, and unbilled services.
- Ensure proper preparation and submission of daily billing and collection reports to management.
- Identify billing discrepancies and implement corrective measures.
- Ensure compliance with hospital billing procedures and financial controls.
B. Insurance and TPA Billing Management
- Manage the complete insurance billing process for cashless and reimbursement cases.
- Coordinate with insurance companies, Third-Party Administrators (TPAs), and corporate clients.
- Ensure timely submission of pre-authorization requests for planned and emergency admissions.
- Verify patient insurance eligibility, policy validity, coverage, exclusions, and applicable limits.
- Coordinate with doctors, nursing staff, medical records, pharmacy, and other departments to obtain the necessary documentation.
- Ensure accurate preparation and submission of final bills, discharge summaries, investigation reports, prescriptions, and other supporting documents.
- Monitor claim submissions, query responses, approvals, deductions, and settlements.
- Follow up on pending claims, delayed payments, short settlements, and rejected claims.
- Analyse claim rejections and deductions and implement corrective actions to minimize revenue loss.
- Ensure compliance with insurance company and TPA billing guidelines, agreed package rates, and contractual terms.
- Maintain proper records of insurance claims, outstanding amounts, approvals, and settlements.
- Coordinate with the finance department for insurance receivables reconciliation.
- Ensure timely resolution of billing queries raised by insurance companies and TPAs.
- Monitor insurance-related discharge processes to minimize delays for patients.
C. Insurance Empanelment and Corporate Tie-Ups
- Identify and coordinate with insurance companies, TPAs, corporate organizations, and other healthcare payers for hospital empanelment.
- Handle the complete empanelment process, including application preparation, document submission, follow-ups, and agreement execution.
- Prepare and maintain hospital documents required for empanelment, including registrations, licences, certifications, infrastructure details, doctor profiles, and other supporting records.
- Coordinate with insurance companies and TPAs for hospital inspections, audits, and credential verification.
- Negotiate and coordinate with management regarding package rates, tariffs, payment terms, and contractual conditions.
- Review empanelment agreements, tariff structures, package rates, exclusions, and billing guidelines before implementation.
- Coordinate with management and the legal department for agreement review and renewal.
- Maintain an updated database of empanelled insurance companies, TPAs, corporate clients, and their respective agreements.
- Monitor agreement expiry dates and initiate renewal processes well in advance.
- Coordinate with insurance companies for tariff revisions and addition of new medical procedures and services.
- Develop and maintain professional relationships with insurance representatives, TPA officials, and corporate HR teams.
- Identify opportunities to increase insurance and corporate patient volumes.
D. Revenue Cycle Management and Outstanding Follow-Up
- Monitor the complete revenue cycle from patient registration and billing to claim submission and final payment.
- Review daily, weekly, and monthly billing and collection performance.
- Track insurance and corporate receivables and ensure timely follow-up.
- Prepare ageing reports for outstanding claims and unpaid invoices.
- Coordinate with the finance team to reconcile insurance receivables and payment records.
- Identify revenue leakages arising from missed charges, incorrect tariffs, unauthorized discounts, and documentation errors.
- Monitor claim settlement timelines and escalate long-pending cases to the concerned authorities.
- Develop strategies to reduce billing errors, claim rejections, and outstanding receivables.
- Ensure proper documentation and audit trails for all financial transactions.
- Support internal and external audits relating to billing, insurance claims, and collections.
E. Team Management and Coordination
- Supervise billing executives, cash billing staff, insurance coordinators, and empanelment personnel.
- Allocate duties and responsibilities to team members and monitor their performance.
- Train staff on hospital billing software, insurance procedures, tariff structures, and documentation requirements.
- Ensure adequate staffing and smooth functioning of billing operations across shifts.
- Conduct regular reviews of billing accuracy, claim processing, collections, and pending cases.
- Coordinate with the following departments:
- Front Office and Patient Registration
- Finance and Accounts
- Medical Records Department (MRD)
- Pharmacy
- Nursing Department
- Doctors and Consultants
- Operations and Administration
- Corporate and Marketing Departments
- Resolve patient billing complaints and insurance-related grievances professionally.
- Ensure adherence to hospital policies, confidentiality requirements, and departmental SOPs.
F. Hospital Billing Software and MIS Reporting
- Ensure effective use of hospital information systems (HIS/HMS) and billing software.
- Monitor correct tariff mapping, package configuration, billing entries, and insurance coding where applicable.
- Ensure accurate recording of cash, insurance, and corporate transactions.
- Generate and analyse daily, weekly, and monthly MIS reports.
- Prepare reports covering:
- Daily cash collections.
- OPD and IPD billing.
- Insurance and corporate billing.
- Cashless pre-authorizations.
- Claims submitted and settled.
- Pending insurance claims.
- Claim rejections and deductions.
- Outstanding receivables and ageing.
- Discounts, refunds, and concessions.
- Empanelment status and agreement renewals.
- Present billing and revenue performance reports to management.
- Recommend improvements in billing processes, reporting accuracy, and revenue collection.
3. Required Qualifications
- Bachelor's degree in Commerce, Finance, Business Administration, Hospital Administration, or a related field.
- MBA in Hospital Administration, Healthcare Management, or Finance is preferred.
- Additional training or certification in hospital revenue cycle management or medical billing is an advantage.
4. Required Experience
- 5–8 years of experience in hospital billing, insurance billing, and revenue cycle management.
- Previous experience handling a hospital billing team in a multispecialty hospital is preferred.
- Practical experience in cashless insurance processing, TPA coordination, corporate billing, and insurance empanelment is essential.
- Experience handling insurance claim rejections, deductions, outstanding receivables, and settlement follow-ups.
- Knowledge of hospital billing software and MIS reporting.
5. Required Skills
- Strong knowledge of hospital cash and insurance billing procedures.
- Knowledge of insurance companies, TPAs, and cashless authorization processes.
- Experience in insurance empanelment and corporate tie-ups.
- Strong financial reconciliation and analytical skills.
- Excellent negotiation and communication skills.
- Team leadership and staff management capabilities.
- Good knowledge of MS Excel, MIS reports, and hospital billing software.
- Ability to handle patient billing disputes and insurance escalations.
- Strong attention to detail and accuracy.
- Ability to work under pressure and meet deadlines.
6. Key Performance Indicators (KPIs)
The performance of the Senior Hospital Billing Manager will be evaluated based on the following:
S. No.Performance IndicatorExpected Outcome1Cash Billing AccuracyMinimal billing errors2Daily Cash Reconciliation100% reconciliation and timely reporting3Insurance Claim SubmissionTimely submission of complete claims4Pre-Authorization ProcessingTimely processing and follow-up5Claim Rejection RateContinuous reduction in avoidable rejections6Insurance OutstandingReduction in ageing receivables7Claim SettlementImproved collection and settlement timelines8Insurance EmpanelmentAchievement of approved empanelment targets9Billing ComplaintsTimely resolution of billing-related complaints10MIS ReportingAccurate and timely submission of reports11Revenue LeakageIdentification and prevention of billing losses12Team PerformanceImproved productivity and billing accuracy
Note: Specific numerical targets should be established by management based on hospital size, payer contracts, claim volumes, and existing performance.
7. Authority and Accountability
The Senior Hospital Billing Manager will be responsible for:
- Supervising daily billing operations and staff performance.
- Monitoring billing accuracy and collection reconciliation.
- Escalating unusual discounts, refunds, and billing adjustments for approval.
- Coordinating with insurance companies and TPAs regarding claims and settlements.
- Recommending insurance empanelment opportunities and tariff revisions.
- Ensuring proper documentation and compliance with hospital policies.
- Reporting billing discrepancies, revenue losses, and operational challenges to management.
8. Expected Deliverables
The employee is expected to ensure:
- Smooth and accurate cash and insurance billing operations.
- Timely processing and submission of insurance claims.
- Effective follow-up of pending claims and outstanding receivables.
- Expansion and maintenance of insurance and corporate empanelments.
- Reduction in avoidable claim rejections and billing discrepancies.
- Accurate daily collection reports and monthly revenue MIS.
- Improved coordination between billing, finance, clinical, and administrative teams.
- Continuous improvement in the hospital's revenue cycle and financial performance.
Pay: ₹50,000.00 - ₹60,000.00 per month
Work Location: In person
