Experienced Medical Claims Manager

2 days ago

Cochin, Kerala, India beBeeClaims Full time ₹ 15,00,000 - ₹ 25,00,000
Job Title: Experienced Medical Claims Manager

The Medical Claims Manager plays a vital role in the revenue cycle management process. This professional oversees the entire claims submission process, ensuring timely and accurate payment from payers.

  • Oversee the accurate and timely processing of claims to ensure compliance with industry regulations and payer guidelines.
  • Review and address billing discrepancies, rejections, and denials, implementing corrective actions as needed.
  • Develop and implement effective claims policies and procedures to enhance overall revenue cycle efficiency.
  • Collaborate with coding, compliance, and other departments to ensure accurate coding and documentation.
  • Analyse billing data and metrics to identify trends, issues, and opportunities for process improvements.
  • Ensure proper follow-up on unpaid or denied claims and manage the appeals process.
  • Oversee the use of electronic health record (EHR) systems and billing software, ensuring they are up-to-date and functioning properly.
  • Stay informed about changes in U.S. revenue cycle management practices and federal regulations to ensure billing processes remain compliant and optimized.
  • Provide guidance and training to team members on evolving industry standards and policy updates.
Required Skills and Qualifications
  • Bachelor's degree in business administration, healthcare administration, finance, or a related field is required. Advanced degrees or certifications (e.g., Certified Professional Biller (CPB)) are highly valued.
  • Proven experience with billing systems, payer guidelines, and regulatory compliance.
  • Strong understanding of U.S. revenue cycle management, including billing workflows, reimbursement methodologies, and common challenges.
  • Up-to-date knowledge of federal regulations, policy changes, and industry standards impacting medical billing practices.
  • Familiarity with electronic health records (EHR) systems and billing software.
  • Strong analytical skills, attention to detail, and ability to work independently.
  • Excellent communication and collaboration skills.

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