IP Billing Operations
- Manage end-to-end inpatient billing operations across all specialties.
- Ensure timely bill preparation and patient discharge without delays.
- Monitor accurate posting of pharmacy, laboratory, radiology, OT, ICU, room rent, consumables, implants, and professional charges.
- Review high-value bills before final settlement.
- Ensure compliance with hospital tariff structures and billing policies.
Government Scheme Billing
- Oversee billing and claim documentation for:
- CGHS
- ECHS
- ESIC
- Ayushman Bharat (PM-JAY)
- State Government Health Schemes (SAST, Arogya Karnataka, Yeshasvini, etc.)
- Ensure adherence to package rates, eligibility criteria, documentation requirements, and claim submission timelines.
- Coordinate with scheme coordinators and government authorities for issue resolution.
- Monitor claim rejections and implement corrective actions to improve claim acceptance.
Insurance & Corporate Billing
- Manage billing for cashless and reimbursement insurance cases.
- Coordinate with TPAs and insurance companies for approvals, billing clarifications, and claim settlements.
- Review corporate billing and credit billing processes.
- Resolve escalated insurance and corporate billing issues.
- Ensure complete documentation for claim processing.
Revenue Cycle Management
- Ensure maximum revenue capture and minimize revenue leakage.
- Monitor pending charges, unbilled services, and billing discrepancies.
- Review daily revenue reports and outstanding billing.
- Identify trends affecting revenue realization and recommend improvements.
Team Leadership
- Lead, mentor, and supervise IP Billing Executives, Senior Associates, and Team Leads.
- Allocate work based on workload and patient volumes.
- Conduct performance reviews and identify training needs.
- Ensure adequate staffing during peak hours and holidays.
MIS & Analytics
- Prepare and review daily, weekly, and monthly MIS reports.
- Monitor:
- Revenue performance
- Billing TAT
- Discharge TAT
- Insurance approvals
- Government scheme claims
- Corporate receivables
- Rejections and deductions
- Present dashboards and action plans to senior management.
Audit & Compliance
- Ensure compliance with NABH standards, statutory regulations, and hospital billing policies.
- Conduct internal billing audits and identify process gaps.
- Support external audits by insurance companies and government agencies.
- Maintain complete billing documentation for audit purposes.
Process Improvement
- Develop and implement SOPs for billing operations.
- Drive automation and process improvement initiatives.
- Reduce billing errors and improve billing turnaround time.
- Implement CAPA for recurring billing issues.
Stakeholder Management
- Coordinate with consultants, nursing, pharmacy, laboratory, radiology, finance, medical records, insurance desk, and patient services.
- Resolve escalated patient billing concerns professionally.
- Work closely with clinical departments to ensure complete charge capture.
Work Location: In person
