Operations Manager

Job description

Position: Manager IP & OP Billing & Financial Counselling Department: Billing / Revenue Cycle Management Designation: Manager Location: Nampally Industry: Hospital / Healthcare Reporting To: Unit Head / Hospital Administration / Finance Head Job Summary We are looking for an experienced and result-oriented Manager – IP & OP Billing & Financial Counselling to oversee hospital billing operations, revenue management, and financial counselling services. The role will be responsible for ensuring accurate and timely billing, effective coordination with clinical and non-clinical departments, smooth patient financial counselling, and adherence to hospital policies and statutory requirements. The candidate should have strong knowledge of IP & OP billing, insurance/TPA processes, government schemes, cash billing, credit billing, financial counselling, collections, and revenue cycle management. Key Responsibilities 1. IP & OP Billing Operations • Manage and supervise day-to-day IP and OP billing operations. • Ensure accurate and timely generation of patient bills. • Monitor admission, discharge, interim and final billing processes. • Ensure proper posting of services, procedures, pharmacy, investigations, implants and other chargeable items. • Monitor billing errors, cancellations, refunds, discounts and adjustments. • Ensure proper documentation and authorization for all billing transactions. • Resolve billing-related issues and patient queries promptly. 2. Financial Counselling • Lead the Financial Counselling team and ensure effective counselling of patients and attendants. • Explain estimated treatment costs, packages, deposits, room charges and other financial requirements. • Provide patients with clear information regarding treatment-related expenses. • Counsel patients regarding available payment options, insurance/TPA coverage and applicable hospital schemes. • Ensure timely communication of revised estimates in case of changes in treatment plans. • Handle escalated financial concerns and support patient satisfaction. 3. Insurance / TPA / Government Schemes • Coordinate with Insurance and TPA teams for smooth claim processing. • Monitor pre-authorizations, enhancements, approvals and final claim submissions. • Ensure proper documentation and timely submission of claims. • Monitor pending approvals, deductions, rejections and claim discrepancies. • Coordinate with concerned departments for resolution of insurance/TPA issues. • Ensure effective handling of applicable government and corporate schemes such as CGHS, EHS and other empanelled schemes, as applicable. 4. Revenue Cycle Management • Monitor the complete billing and collection cycle from registration/admission to final settlement. • Track outstanding amounts and ensure timely collection. • Monitor credit patients, corporate accounts, insurance receivables and other outstanding balances. • Analyze revenue leakage and implement corrective measures. • Prepare and review daily, weekly and monthly billing and collection reports. • Monitor key revenue and billing performance indicators. 5. Team Management • Lead, supervise and motivate IP billing, OP billing and financial counselling teams. • Allocate responsibilities and ensure adequate manpower coverage. • Conduct regular team meetings and performance reviews. • Identify training requirements and provide necessary guidance. • Establish and monitor team productivity and quality standards. • Ensure adherence to hospital SOPs and billing policies. 6. Coordination • Coordinate closely with Doctors, Nursing, Front Office, Medical Records, Pharmacy, Diagnostics, OT, Finance, Insurance/TPA and Administration teams. • Ensure timely communication between clinical and billing departments. • Coordinate with doctors and clinical teams regarding package applicability, procedures and billing requirements. • Support smooth discharge and settlement processes. 7. Audit & Compliance • Ensure compliance with hospital billing policies, SOPs and applicable statutory requirements. • Conduct regular billing audits to identify errors and revenue leakages. • Ensure proper authorization for discounts, refunds, write-offs and adjustments. • Maintain confidentiality and security of patient financial information. • Support internal and external audits whenever required. 8. MIS & Reporting Prepare and review regular reports including: • IP Billing Revenue • OP Billing Revenue • Daily Collection Report • Pending Billing Report • Outstanding Report • Insurance / TPA Pending Report • Discharge Billing TAT • Financial Counselling Conversion / Collection Report • Discounts and Refunds Report • Revenue Leakage / Billing Error Report • Department-wise revenue performance Key Performance Indicators (KPIs) • Billing accuracy and error percentage • IP & OP billing turnaround time • Discharge billing TAT • Collection efficiency • Outstanding reduction • Insurance/TPA claim submission TAT • Reduction in claim rejections and deductions • Financial counselling effectiveness • Revenue leakage reduction • Patient satisfaction related to billing • Team productivity and manpower utilization Eligibility & Experience • Graduate / Postgraduate in Finance, Hospital Administration, Healthcare Management, Commerce or related field. • 8–12 years of relevant experience in hospital billing / revenue cycle management, with managerial or supervisory experience. • Strong experience in IP & OP Billing and Financial Counselling. • Experience in a hospital environment is mandatory/preferred. • Good knowledge of Insurance, TPA, Corporate Billing and Government Schemes. • Experience handling billing teams and coordinating with multiple hospital departments.