Job Description

Job Title: Hospital Manager - Insurance & Package Billing Operations

Department

: Administration / Billing & Revenue Cycle Management

Reports To

: Hospital Administrator / CEO / Director - Operations

Experience

: 5-10 years in hospital administration or revenue cycle management with TPA/insurance exposure

Education

: Bachelor's/Master's degree in Hospital Administration, Healthcare Management, or related field

Job Summary:

We are seeking a detail-oriented and experienced

Hospital Manager

with a strong understanding of

package billing, insurance, and TPA operations

within the Indian healthcare ecosystem. The role involves managing and streamlining

end-to-end package billing processes

, ensuring compliance with government and private insurance providers, and maximizing revenue realization for the hospital.

Key Responsibilities:

1. Package Billing Management

Oversee the end-to-end billing process for

cashless and reimbursement packages

, including Ayushman Bharat (PMJAY), CGHS, ECHS, state schemes, and corporate insurance packages. Ensure accurate mapping of

treatment packages

as per TPA/Insurance empanelment agreements. Monitor

pre-authorisation, enhancement

, and

final billing

processes. Validate documentation and clinical coding to ensure compliance with the package definition.

2. Insurance & TPA Coordination

Liaise with all empanelled

insurance companies, TPAs, and government health schemes

. Submit necessary documentation for pre-authorization, follow-ups, discharge summaries, and post-treatment bills. Ensure timely submission of claims and

reduce rejections/denials

by improving documentation quality. Coordinate with medical, nursing, and billing teams for smooth processing of claims.

3. Revenue Cycle & Claims Management

Supervise

claim generation, submission, tracking, and reconciliation

. Monitor outstanding dues and follow up for payments with insurers and TPAs. Analyze denial reasons and initiate

corrective measures

to prevent future rejections. Ensure

TAT (Turnaround Time)

adherence for discharge billing and claim submissions.

4. Compliance & Audit

Ensure billing complies with

IRDAI, NABH, and government regulatory norms

. Prepare for internal/external audits of insurance and package billing. Maintain records and logs for transparency and reporting.

5. Reporting & MIS

Generate daily, weekly, and monthly

MIS reports

for package utilization, claims submitted, payments received, and pending. Provide input for strategic pricing decisions and package negotiations. Present insights to management for revenue improvement.

6. Team Management & Training

Lead and manage a team of billing executives and coordinators. Train staff on billing protocols, documentation standards, and system updates. Develop SOPs for package billing and insurance processing.

Key Skills & Competencies:

In-depth knowledge of

TPA operations, insurance billing

, and

healthcare packages

in India. Understanding of billing code wise with insurer and TPAs' Familiarity with

healthcare IT systems (HIS/ERP), e-filing portals, and TPA software

. Strong

communication and coordination skills

with medical and non-medical teams. Good understanding of

hospital finance, compliance

, and

revenue leakage control

. Analytical skills with proficiency in

Excel and MIS reporting

.

Preferred Qualifications:

Experience working in NABH-accredited hospitals. Exposure to

state/central government health schemes

(PMJAY, CGHS, etc.). Certification in Medical Billing/Coding (optional but preferred).

Salary & Benefits:

Competitive salary [Specify Range] based on experience. Performance-based incentives. Health insurance and additional staff welfare benefits.
Job Types: Full-time, Permanent

Pay: Up to ₹45,000.00 per month

Work Location: In person