Operations Manager

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.