Aakash Healthcare - Agra

Vacancy Details

Urgently Required: TPA Manager

Hospital: Aakash Healthcare – Agra

Location: Mathura

Experience: 6 to 10 years

Number of Vacancies: 1

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The Insurance Manager in a healthcare organization plays a pivotal role in overseeing the insurance operations, including the management of insurance claims, verification of patient insurance coverage, and ensuring that the organization adheres to all insurance regulations and payer contracts.
This role requires a deep understanding of healthcare insurance policies, billing procedures, and payer requirements.
The Insurance Manager ensures efficient processing of insurance claims, maximizes revenue through effective claims management, and maintains strong relationships with insurance providers.

Insurance Claims Management: Oversee the submission of accurate and timely insurance claims, monitor the claims process, and ensure prompt resolution of denied or disputed claims.
Verification and Authorization: Ensure that patient insurance coverage is verified, and necessary authorizations are obtained prior to service delivery.
Compliance: Maintain compliance with insurance regulations, payer contract requirements, and healthcare laws such as HIPAA.
Team Leadership: Manage and train the insurance processing team, providing guidance on insurance policies, billing procedures, and compliance matters.
Revenue Optimization: Implement strategies to minimize claim denials, expedite payment collections, and ensure that the organization is reimbursed correctly according to payer contracts.
Payer Relations: Establish and maintain positive relationships with insurance payers, negotiate contracts, and address any issues or disputes that arise.
Reporting and Analysis: Generate reports on insurance claim status, denials, reimbursements, and payer contract performance to identify trends and areas for improvement.
Patient Support: Provide support and information to patients regarding their insurance coverage, benefits, and responsibilities.

Educational Background: Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or related field. Advanced degrees or specific insurance/billing certifications (e.g., Certified Professional Coder [CPC]) are advantageous.
Experience: Several years of experience in healthcare insurance or billing, with a proven track record in managing insurance operations and leading teams.
Skills and Competencies: Comprehensive knowledge of insurance policies, healthcare billing, and regulatory compliance; strong leadership and team management skills; excellent negotiation and communication abilities; and proficiency in healthcare billing software.

Analytical Skills: Ability to analyze insurance processes, identify inefficiencies, and implement effective solutions.
Detail-Oriented: Meticulous attention to detail to ensure accuracy in insurance verification, claims submission, and compliance documentation.
Leadership: Strong leadership and organizational skills to manage and motivate the insurance processing team.
Negotiation Skills: Effective negotiation skills for dealing with insurance payers and resolving disputes.
Problem-Solving: Proactive in addressing and resolving issues related to insurance claims and coverage.

Mathura Job ID: 100357111

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TPA Manager