Claims Manager - Operations - Healthcare

Job Description: Claims Manager

Location: Bangalore

Job Type: Full-time

Company: Connect and Heal

About Us:

Connect and Heal is a leading healthcare organization dedicated to providing high-quality medical services to our patients. We are committed to ensuring that our patients receive the best care possible, and part of that commitment involves managing and processing outpatient department (OPD) reimbursement claims efficiently and accurately.

Job Description:

We are seeking an experienced and detail-oriented OPD Reimbursement Claims Manager to join our team. In this role, you will be responsible for overseeing the entire OPD reimbursement claims process, ensuring that claims are processed accurately, efficiently, and in compliance with all relevant regulations and guidelines. The successful candidate should have a strong background in healthcare reimbursement, excellent organizational skills, and the ability to lead a team effectively.

Key Responsibilities:

- Claims Processing: Process outpatient department reimbursement claims promptly and accurately, verifying patient information, treatment details, and insurance coverage.

- Team Management: Lead and manage a team of claims processors, providing guidance, training, and support to ensure the team's success.

- Quality Assurance: Implement and maintain quality assurance procedures to ensure that all claims are processed correctly and in accordance with industry standards.

- Compliance: Stay up-to-date with healthcare regulations, insurance policies, and coding updates to ensure claims compliance and minimize denial rates.

- Documentation: Maintain accurate and organized records of all claims, correspondence, and related documentation.

- Communication: Communicate with insurance companies, healthcare providers, and patients to resolve any claim-related issues, disputes, or inquiries.

- Reporting: Generate reports and analytics related to claims processing, denial rates, reimbursement trends, and other relevant metrics to provide insights for process improvement.

- Process Improvement: Continuously identify areas for process improvement and efficiency enhancement, implementing necessary changes to streamline operations.

- Training: Conduct regular training sessions for staff to ensure they are updated on best practices and industry changes.

- Customer Service: Provide excellent customer service to patients and other stakeholders, addressing their concerns and questions regarding reimbursement claims.

Qualifications:

- Bachelor's degree in healthcare administration, business, or a related field (Master's degree preferred).

- At least 2-3 years of experience in healthcare claims processing, with a minimum of 4-5 years in a supervisory or managerial role.

- Strong knowledge of healthcare reimbursement policies, procedures, and coding systems (CPT, ICD-10, HCPCS).

- Proficiency in using healthcare software and claims processing systems.

- Proficiency in MS Office applications( MS Excel is a must).

- Excellent analytical, problem-solving, and communication skills.

- Detail-oriented with a high level of accuracy.

- Strong leadership and team management abilities.

- Knowledge of relevant healthcare laws, regulations, and compliance requirements.