Job Summary
The Healthcare Insurance & Billing Executive is responsible for managing patient billing, insurance claim processing, reimbursement follow-ups, and coordination with insurance providers. The role ensures accurate claim submission, timely collections, compliance with healthcare regulations, and efficient revenue cycle management.
Key Responsibilities
* Verify patient insurance eligibility and coverage details.
* Coordinate with insurance companies for pre-authorizations and approvals.
* Process cashless hospitalization requests and documentation.
* Follow up with insurance providers regarding claim status and reimbursement.
* Prepare and submit accurate medical bills and insurance claims.
* Ensure proper coding and documentation as per healthcare and insurance guidelines.
* Review patient accounts for billing discrepancies and resolve issues.
* Generate invoices and maintain billing records.
*Medical Billing Track submitted claims and monitor reimbursement status.
* Handle claim denials, rejections, and appeals.
* Coordinate with doctors, nursing staff, and patients to obtain necessary documents.
* Maintain records of outstanding claims and follow up for timely settlement.
* Explain insurance coverage, billing details, and payment responsibilities to patients.
* Respond to patient and insurance-related queries professionally.
* Liaise with TPAs, insurance companies, and internal departments.
* Prepare periodic reports on claims submitted, approvals, rejections, and collections.
* Ensure compliance with hospital policies, insurance regulations, and documentation standards.
* Maintain confidentiality of patient and financial information.
* Bachelor's Degree in Healthcare Management, Commerce, Business Administration, Finance, or related field.
* Certification in Medical Billing, Coding, or Healthcare Insurance (preferred).
* 1–5 years of experience in healthcare billing, insurance processing, TPA coordination, or revenue cycle management.
* Experience in hospitals, clinics, diagnostic centers, or healthcare service organizations preferred.
* Knowledge of health insurance policies, TPAs, and claim processing.
* Understanding of medical billing procedures and healthcare documentation.
* Strong communication and negotiation skills.
* Proficiency in MS Office and Hospital Information Systems (HIS).
* Attention to detail and analytical skills.
* Ability to manage multiple claims and deadlines effectively.
Key Performance Indicators (KPIs)
* Claim submission accuracy rate.
* Insurance claim approval percentage.
* Turnaround time for claim processing.
* Reduction in claim denials and rejections.
* Collection and reimbursement efficiency.
* Patient satisfaction regarding billing and insurance services.
Pay: ₹25,000.00 - ₹30,000.00 per month
Benefits:
- Health insurance
- Provident Fund
Work Location: In person
