MEDICAL BILLING MANAGER
Position Title:
Medical Billing Manager
Department:
Medical Billing / TPA
Reports To:
Hospital Administrator / COO / Finance Head
Job Summary:
The Medical Billing Manager is responsible for managing and supervising all medical billing and revenue cycle operations of the hospital. The incumbent will ensure accurate billing, timely claim submission, reimbursement tracking, and coordination with government and private healthcare schemes such as ECHS, ESI, CGHS, TPAs, and Insurance Companies. The role requires strong knowledge of healthcare billing regulations, package management, claim processing, and revenue optimization.
Key Responsibilities:
Medical Billing
- Oversee end-to-end billing processes for OPD, IPD, Diagnostics, Procedures, and Surgeries.
- Ensure accurate preparation and submission of bills as per hospital and payer guidelines.
- Monitor billing accuracy and prevent revenue leakage.
- Supervise claim generation, submission, tracking, and settlement.
- Ensure timely collection and reconciliation of payments.
ECHS, ESI & CGHS Management
- Handle billing, documentation, and claim submission for ECHS (Ex-Servicemen Contributory Health Scheme) patients.
- Manage ESI (Employees' State Insurance) billing and reimbursement processes.
- Coordinate CGHS (Central Government Health Scheme) patient billing and claim settlements.
- Ensure compliance with package rates, empanelment terms, and government regulations.
- Follow up with concerned authorities for claim approvals and payment realization.
Insurance & TPA Coordination
- Liaise with TPAs and insurance companies for cashless and reimbursement claims.
- Resolve claim rejections, deductions, and discrepancies.
- Monitor outstanding claims and ensure timely settlement.
Team Leadership
- Supervise and guide billing executives, TPA coordinators, and claim processing staff.
- Conduct training on billing procedures and government scheme requirements.
- Monitor team performance and productivity.
Reporting & Compliance
- Prepare monthly billing, collection, and receivable reports.
- Analyze billing trends and recommend revenue improvement strategies.
- Ensure compliance with NABH standards, hospital policies, and statutory regulations.
- Maintain confidentiality of patient and financial records.
Educational Qualification:
- MBBS (Bachelor of Medicine & Bachelor of Surgery) OR
- BAMS (Bachelor of Ayurvedic Medicine & Surgery) OR
- BDS (Bachelor of Dental Surgery)
Experience:
- Minimum 5–8 years of experience in hospital billing, medical claims, TPA operations, or revenue cycle management.
- At least 2–3 years of managerial experience in a multi-specialty hospital.
- Hands-on experience in handling ECHS, ESI, CGHS, TPAs, and Insurance Billing is mandatory.
Required Skills:
- Thorough knowledge of ECHS, ESI, CGHS, Ayushman Bharat, TPA, and Insurance claim processes.
- Strong understanding of medical terminology, procedures, and package billing.
- Excellent analytical, leadership, and problem-solving skills.
- Proficiency in Hospital Information Systems (HIS), Billing Software, and MS Excel.
- Strong communication and negotiation skills.
- Ability to manage multiple stakeholders and meet strict deadlines.
Key Performance Indicators (KPIs):
- Claim approval and settlement rate.
- Reduction in claim rejections and deductions.
- Revenue realization and collection efficiency.
- Outstanding receivables management.
- Billing accuracy and compliance.
- Timely submission of ECHS, ESI, CGHS, and insurance claims.
- Department productivity and staff performance.
Employment Type: Full-Time
Experience Required: 5–8 Years
Qualification: MBBS / BAMS / BDS with expertise in ECHS, ESI, CGHS, TPA & Insurance Billing.
Pay: ₹40,617.72 - ₹100,329.63 per month
Work Location: In person
