Head - Revenue Assurance & Collection - Hospital

MBA Finance

- Candidate should be from Hospital / Healthcare Insurance

- He will co ordinate with Insurance companies for payment collections from Insurance This is a Hospital based job catering to Karnataka region

Key Responsibilities:

1. Credit Management and Policy Development:

- Credit Policy Formulation: Develop, implement, and periodically review the hospital's credit policies to ensure they reflect the institution's operational goals, legal requirements, and industry standards. Establish clear guidelines for granting credit to patients, ensuring a balance between accessibility to healthcare and financial risk management.

- Credit Risk Assessment: Evaluate the creditworthiness of patients and third- party payers (insurance companies, government programs, etc.), using financial assessments and historical data. Analyze patient financial profiles and establish appropriate credit limits.

- Patient Credit Guidelines: Set guidelines for patients who cannot afford upfront payments, including flexible payment plans, interest-free periods, and deferrals. Ensure all credit transactions are well-documented and approved per hospital policies.

- Third-party Credit Negotiations: Lead negotiations with insurance providers, government programs, and third-party payers to ensure optimal credit terms for the hospital, including payment timelines, claim disputes, and reimbursement rates.

- Risk Mitigation Strategies: Identify potential risks in patient credit, insurance claims, and payments, and design mitigation strategies to protect the hospital's revenue cycle. Establish preventive measures for defaults, bad debt, and claim denials.

2. Accounts Receivable Management:

- Aging Report Monitoring: Review and analyze the hospital's accounts receivable aging reports daily/weekly. Identify overdue accounts and prioritize follow-up actions. Monitor aging buckets and categorize according to the level of risk and the expected payment source.

- Collections Strategy Development: Design and implement strategies to improve collections efficiency, reduce outstanding accounts, and lower bad debt. This may include setting up regular reminders, automated follow-ups, or employing third-party collection agencies.

- Accounts Reconciliation: Work closely with the finance and billing departments to ensure accounts are reconciled accurately and discrepancies between billing and payment records are resolved in a timely manner.

- Escalation Procedures: Develop and enforce escalation protocols for accounts that remain overdue beyond a certain threshold, ensuring that they are escalated to senior management or legal departments for further action.

- Patient Payment Follow-ups: Oversee the credit collection team in handling patient accounts, including regular follow-up calls or correspondence with patients to remind them of outstanding bills and to offer payment plans.

3. Insurance Claims and Third-Party Payer Management:

- Insurance Claim Filing & Follow-ups: Oversee the submission of insurance claims to ensure all claims are filed accurately and timely. Develop a process for fast-track claims for urgent or high-value treatments.

- Claim Dispute Resolution: Lead efforts to resolve insurance claim denials or rejections. Investigate causes of denials, coordinate with insurance providers, and provide the necessary documentation for reprocessing claims. Track claim rejection rates and develop action plans to reduce them.

- Payment Verification: Ensure that all payments made by insurance companies are reviewed, reconciled, and posted to the appropriate accounts.

- Investigate any discrepancies between what was paid and what was billed.

- Insurance Contract Negotiations: Coordinate with hospital management to negotiate favourable terms and conditions with insurance providers, ensuring that the hospital's financial interests are protected while maintaining productive relationships with insurers.

- Third-party Payment Integration: Work with third-party payers, including government programmes to ensure accurate and timely reimbursement.

- Understand the nuances of different payer requirements and ensure compliance with all necessary regulations.

4. Team Leadership and Staff Management:

- Team Supervision and Development: Lead, manage, and mentor a team of credit officers, billing staff, and collections agents. Set clear performance targets and KPIs (Key Performance Indicators) for team members and ensure regular performance reviews and feedback.

- Training and Development: Organize regular training sessions to educate the credit team on the latest credit policies, billing systems, insurance claim processes, and relevant regulatory changes. Foster a culture of continuous improvement within the team.

- Performance Monitoring: Track individual and team performance against credit collection goals, aging reports, and financial KPIs. Provide regular feedback, conduct performance appraisals, and create action plans for any underperforming staff.

- Cross-Departmental Coordination: Collaborate with other departments, such as Finance, Billing, Patient Services, and the Clinical Team, to ensure smooth communication and efficient workflow related to patient accounts, claims, and credit assessments.

5. Financial Reporting and Analysis:

- Accounts Receivable Reporting: Generate and present regular reports on the status of the accounts receivable portfolio, detailing overdue balances, aging reports, and collections progress. Provide actionable insights and recommendations to the senior management team to improve cash flow.

- Cash Flow and Revenue Cycle Optimization: Develop strategies to optimize the hospital's cash flow, improve payment timelines, and reduce the time between service delivery and payment receipt. Regularly review revenue cycle processes to ensure efficiency and accuracy.

- Bad Debt Analysis: Conduct detailed analysis of bad debt and identify areas where policies, processes, or staff performance may need improvement. Work with senior management to develop strategies for minimizing bad debt.

6. Stakeholder Management and Communication:

- Internal Stakeholder Communication: Regularly report to senior management, including the CFO on the status of credit management activities, payment collections, and financial health. Provide strategic insights and recommendations to improve hospital revenue management.

- Patient Communication: Oversee patient interactions regarding financial queries, including explaining payment terms, credit policies, and payment plan options. Ensure that patients are treated with empathy and professionalism when discussing sensitive financial matters.

- Insurance and Third-party Relationship Management: Build and maintain strong relationships with insurance companies, government agencies, and other third-party payers. Ensure that communication is clear and timely

- Legal Liaison for Collections: Coordinate with legal counsel when legal action is necessary for collection efforts, such as filing lawsuits for unpaid balances or dealing with bankruptcies.

7. Regulatory Compliance and Risk Management:

- Legal Compliance: Ensure the credit cell's operations are in full compliance with all applicable healthcare financial regulations, ensuring that patient privacy, billing, and collections practices follow legal and ethical standards.