Senior Billing Manager

Job Summary

We are seeking an experienced Senior Billing Manager to oversee and optimize our hospital's end-to-end patient billing, medical coding compliance, and insurance claims processing. This role leads the patient accounts team across Inpatient (IPD), Outpatient (OPD), and Emergency departments, ensuring seamless revenue flow, minimal claim denials, strict adherence to healthcare regulations, and a transparent, compassionate billing experience for patients.

Key Responsibilities

Revenue Cycle & Billing Operations

• Oversee daily billing and collections operations across OPD, IPD, Day Care, and Emergency services.

• Ensure accurate charge capture for doctor visits, surgical procedures, nursing care, ICU stays, pharmacy, and diagnostic tests.

• Monitor Cashless/TPA (Third Party Administrator) and government scheme (e.g., Ayushman Bharat/State schemes) billing, approval, and settlement workflows.

• Lead monthly revenue audit cycles to identify billing leakages, unbilled procedures, and charge code errors.

Insurance & Claims Management

• Supervise claim preparation, submission, and re-adjudication with private insurance companies and TPAs.

• Implement robust strategies to reduce claim rejection rates, track aging accounts receivable, and oversee denial management protocols.

• Coordinate with medical superintendents and doctors to complete necessary clinical documentation for medical necessity approvals.

Patient Relations & Escalations

• Ensure transparent financial counseling for patients at admission and transparent interim/final bill generation at discharge.

• Directly handle complex billing disputes, disputed line items, or corporate account queries with sensitivity and speed.

• Establish clear protocols for advance deposits, estimate generation, and charity/discount approval workflows.

Team Leadership & Regulatory Compliance

• Mentor and manage a multi-shift team of billing executives, discharge coordinators, and insurance desk personnel.

• Ensure strict compliance with medical tariff structures, government capping guidelines (e.g., implants, consumables), and hospital accreditation standards (NABH/JCI).

• Evaluate and optimize Hospital Information System (HIS) software to streamline digital discharge and billing turn-around times (TAT).

Requirements & Qualifications

• Education: Bachelor’s degree in Healthcare Management, Commerce, Business Administration, or related fields (Master’s in Hospital Administration (MHA) / MBA preferred).

• Experience: 7–12+ years of progressive experience in hospital billing and RCM operations, with at least 3+ years managing a mid-to-large-scale hospital billing team.

• Technical Skills:

  • Hands-on proficiency in major Hospital Information Systems (HIS) and EMR platforms (e.g., Meditech, Cerner, Napier, Practo, or custom hospital ERPs).

  • Deep knowledge of medical coding standards (ICD-10, CPT) and TPA/Insurance portal operations.

  • Advanced MS Excel proficiency for revenue analytics and aging reports.

• Key Competencies: High emotional intelligence for patient interactions, strong leadership, deep understanding of healthcare tariff structures, and analytical problem-solving.