Job Description: Head Billing, TPA & Government Panel DepartmentLocation: Vedansh Surya Hospital, Greater Noida Department: Billing, TPA & Government Panel Claims (ECHS, CGHS, CAPF, PSU, ESI, TPA, Ayushman Bharat) Reports To: Hospital Director / DMS Role Overview:The Head Billing, TPA & Government Panel Department at Vedansh Surya Hospital will oversee the entire hospital billing process, ensuring seamless claim submission, payment follow-ups, and revenue cycle optimization for cash, corporate, insurance, TPA, and government health schemes, including Ayushman Bharat (PMJAY), ECHS, CGHS, CAPF, PSU, and ESI. This role requires strong coordination with insurance companies, government authorities, and TPAs to maximize claim settlements and minimize rejections or delays. Key Responsibilities:1. Billing & Revenue Cycle ManagementSupervise the entire billing process across cash, credit, insurance, government panel, and Ayushman Bharat patients.Ensure accurate and transparent patient billing, including charge capturing, invoice generation, and payment collection.Implement Standard Operating Procedures (SOPs) to prevent revenue leakage and billing discrepancies.Coordinate with clinical, finance, and IT departments to streamline charge capture and documentation.2. TPA & Insurance Claims ManagementAct as the primary liaison between the hospital and TPAs, insurance providers, and corporate clients.Ensure timely claim submission, approvals, and follow-ups for TPA and insurance cases.Address claim denials, disputes, and resubmit rejected claims with necessary justifications.Negotiate empanelment agreements with TPAs and insurance providers for better reimbursement terms.Track pending insurance claims, initiate follow-ups, and ensure timely settlements.3. Government Panel Claims (ECHS, CGHS, CAPF, PSU, ESI, etc.)Oversee billing and documentation for patients under government panel schemes.Ensure timely claim submission and follow-up for ECHS, CGHS, CAPF, PSU, and ESI panels.Develop and maintain strong coordination with government authorities and panel representatives.Monitor pending and settled claims, ensuring a smooth reimbursement process.Ensure compliance with panel guidelines and empanelment agreements.4. Ayushman Bharat (PMJAY) Billing & Claims ManagementOversee the Ayushman Bharat (PMJAY) billing process, ensuring compliance with scheme guidelines.Ensure timely pre-authorization, approvals, and claim submissions for Ayushman Bharat beneficiaries.Coordinate with State Health Authorities (SHA) and PMJAY nodal officers to resolve claim-related issues.Track pending claims, rejections, and payments from the Ayushman Bharat portal.Ensure Ayushman Bharat SOP compliance to prevent claim rejections and revenue losses.5. Payment Recovery & Follow-UpsRegularly follow up on outstanding payments from TPAs, insurance companies, and government panels.Identify and escalate long-pending claims for quick resolution.Ensure all necessary documentation is submitted on time to avoid payment delays.Maintain strong coordination with Ayushman Bharat, ECHS, CGHS, and other government authorities for faster reimbursement.6. Financial Compliance & MIS ReportingEnsure compliance with NABH, IRDAI, and government health scheme regulations.Generate MIS reports for management on revenue, outstanding claims, settlement timelines, and rejections.Conduct periodic reconciliation of pending payments with the finance department.Monitor KPIs related to claim processing, billing efficiency, and payment turnaround time.7. Team Leadership & TrainingManage a team of billing executives, TPA coordinators, and government panel claim processors.Conduct training programs to keep the team updated on billing procedures, insurance policies, and government schemes.Assign workflows, monitor staff performance, and resolve operational bottlenecks.8. Patient Experience & Grievance HandlingEnsure smooth patient interactions regarding billing, insurance, and government scheme-related queries.Resolve patient grievances and disputes related to claim rejections, billing transparency, and payments.Enhance billing transparency to improve patient satisfaction and trust. Key Skills & Competencies:Hospital Billing Expertise – Strong knowledge of hospital billing systems, revenue cycle management, and government health schemes. TPA & Insurance Knowledge – Expertise in handling TPA, insurance, and corporate claims. Government Panel & Ayushman Bharat Expertise – Experience in handling ECHS, CGHS, CAPF, PSU, ESI, and Ayushman Bharat billing. Financial Acumen – Understanding of hospital finance, claim reconciliation, and cost control. Negotiation & Follow-up Skills – Ability to coordinate with government authorities, TPAs, and insurance providers. Leadership & Team Management – Experience in managing and training billing, TPA, and claims processing teams. Patient-Centric Approach – Strong communication and problem-solving skills to handle patient and insurance queries. Qualifications & Experience:Education:MBA / MHA (Master’s in Hospital Administration) / PG Diploma in Healthcare Management / Finance.Bachelor’s degree in Commerce, Finance, or a related field.Experience:5-7 years of experience in hospital billing, TPA, and government health schemes.Minimum 2 years in a leadership role managing hospital billing, TPA, and government panel operations.Technical Skills:Proficiency in Hospital Management Software (HMS), TPA Portals, Government Panel Portals, and Ayushman Bharat Portal.Hands-on experience with MIS reporting, Excel, and financial reconciliation tools. KPIs (Key Performance Indicators): Claim settlement turnaround time (Insurance, Government Panels, and Ayushman Bharat). Reduction in claim denials and rejections. Timely approvals and disbursement of Ayushman Bharat claims. Revenue collection from TPAs & Government Panels. Efficiency in pre-authorization and approvals. Patient satisfaction scores related to billing transparency. Timely follow-ups and reduction in outstanding dues. Salary Compensation: As per industry standards (Negotiable based on experience).
