Manager - Billing & Insurance

Main Objective Of The Role

To lead and oversee all billing and insurance operations, ensuring accurate and timely invoicing, insurance claim processing, revenue cycle efficiency, and compliance with regulatory requirements. Responsible for optimizing reimbursement processes, minimizing denials, and maintaining effective relationships with insurance providers, patients, and internal departments.

Roles & Responsibilities

• 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

Any graduation is acceptable, but B.Com is preferred.

Language : Kannada & English

Must have skills

Skills Required

Team Management, Claims Processing