- Billing Operations Management
- Supervise and manage OP & IP billing teams.
- Ensure accurate and timely generation of patient bills.
- Monitor daily billing activities, reconciliations, and cash collection.
- Validate service coding (ICD/CPT) and pricing in accordance with policies.
- Generate and present daily, weekly, and monthly collection reports to senior leadership.
- Analyze aging reports, highlight trends, and propose corrective actions.
- Insurance Coordination & Claims Processing
- Oversee pre-authorization, insurance eligibility verification, and approvals.
- Supervise submission of insurance claims and monitor turnaround times.
- Follow up on pending claims and coordinate with insurers for settlement.
- Address claim rejections, denials, and initiate appeals as necessary.
- Compliance & Documentation
- Ensure compliance with medical billing regulations and insurer requirements.
- Maintain accurate documentation of billing and insurance communications.
- Stay updated with changes in insurance guidelines and tariff revisions.
- Team Management
- Lead and train billing and insurance team members.
- Conduct regular performance reviews and feedback sessions.
- Allocate work schedules and ensure staffing coverage.
- Reporting & Audit
- Generate and analyze daily/weekly/monthly billing and collection reports.
- Support internal and external audits by providing necessary documentation.
- Monitor KPIs such as billing accuracy, claim rejection rate, and AR days.
- Maintain complete documentation of communication and collection efforts.
- Regularly review and update SOPs to reflect current best practices.
- Stakeholder Coordination
- Liaise with clinicians, patient service departments, and finance teams.
- Address patient concerns related to billing or insurance coverage.
Coordinate with TPA/insurance representatives for seamless operations.
Qualifications
B.com,BBA,Any graduation
Must have skills
- Passion for Excellence
- Results Orientation
- Communication Skills
- Customer Focus
Good to have skills
- Building Relationships
- Leadership & Influencing
- Problem Solving and Decision Making
