The HOD – IP, OP & TPA Billing is responsible for overseeing and managing all inpatient (IP), outpatient (OP), and Third-Party Administrator (TPA) billing operations within the hospital. The role ensures accurate billing, timely claim submissions, revenue optimization, compliance with healthcare regulations, and efficient coordination with insurance providers and internal departments.
Billing Operations Management
- Oversee all IP, OP, and TPA billing activities to ensure accuracy and timely processing.
- Monitor patient billing, insurance billing, and cash collections.
- Ensure proper charge capture and billing documentation for all services rendered.
- Review and approve billing reports, adjustments, and refunds.
TPA & Insurance Coordination
- Manage relationships with TPAs, insurance companies, and corporate clients.
- Ensure timely submission and follow-up of insurance claims.
- Monitor claim approvals, denials, rejections, and settlements.
- Resolve billing disputes and coordinate with insurance providers for claim settlements.
Revenue Cycle Management
- Develop strategies to improve revenue collection and reduce claim rejections.
- Monitor outstanding receivables and ensure timely recovery.
- Analyze billing trends and identify areas for revenue enhancement.
- Ensure compliance with hospital billing policies and payer requirements.
Team Leadership & Supervision
- Lead, train, and supervise the IP, OP, and TPA billing teams.
- Allocate work, monitor performance, and provide guidance to staff.
- Conduct regular team meetings and performance evaluations.
- Ensure staff adherence to billing procedures and service standards.
Reporting & Documentation
- Prepare daily, weekly, and monthly billing and revenue reports.
- Maintain accurate records of billing transactions and claim status.
- Present revenue performance reports to management.
- Ensure proper documentation for audits and regulatory compliance.
Required Qualifications
- Bachelor's Degree in Commerce, Finance, Hospital Administration, Healthcare Management, or a related field.
- Master's Degree (MBA/MHA) preferred.
- Certification in Medical Billing or Revenue Cycle Management is an added advantage.
Experience
- 8–12 years of experience in hospital billing, revenue cycle management, or healthcare finance.
- Minimum 3–5 years of experience in a managerial or leadership role.
- Experience handling IP, OP, TPA, insurance, and corporate billing operations.
Required Skills
- Strong knowledge of hospital billing processes and TPA operations.
- Revenue cycle management expertise.
- Leadership and team management skills.
- Excellent communication and negotiation abilities.
- Strong analytical and problem-solving skills.
- Proficiency in Hospital Information Systems (HIS), billing software, and MS Office.
- Ability to work under pressure and meet deadlines.
Key Performance Indicators (KPIs)
- Billing accuracy rate.
- Claim approval and settlement rate.
- Reduction in claim rejections and denials.
- Revenue collection efficiency.
- Outstanding receivables management.
- TAT (Turnaround Time) for billing and claim processing.
- Patient satisfaction levels.
Experience:
- Hospital Billing (IP,TPA,Corporate): 10 years (Required)
Work Location: In person
