Fortis Hospital
Urgently Required
TPA Manager
Experience : 1 to 5 years
No of vacancies : 1
Job Description: 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.
Key Responsibilities: 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.
Education Qualifications: 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.
Key Attributes: 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.
About the Role: Revenue Cycle Steward: Integral to optimizing the revenue cycle through effective management of insurance claims and reimbursements.
Compliance Advocate: Ensures that all insurance processes comply with relevant laws, regulations, and payer contract agreements.
Team Leader: Builds and leads a team capable of efficiently managing the complexities of insurance processing in a healthcare context.
Payer Liaison: Acts as the primary point of contact between the healthcare organization and insurance payers, fostering strong working relationships.
Patient Educator: Provides crucial information to patients regarding their insurance coverage, helping them navigate their benefits and responsibilities.
The Insurance Manager’s role is critical in ensuring the financial vitality of a healthcare organization by managing insurance processes efficiently, upholding compliance standards, and facilitating smooth interactions between patients, providers, and payers.