Healthcare Operations Manager
2 days ago
About the Role:
The Healthcare Operations Manager will drive CarePal Group's trust and safety strategy, overseeing hospital coordination, insurance claim processing, and TPA operations. This role demands a strong experience in setting and running processes in the healthcare insurance domain, including patient admission and discharge, billing verification, risk mitigation, and fraud prevention.
Key Responsibilities:
- Manage relationships with hospital billing departments to ensure seamless service coordination.
- Oversee admission, discharge, and cost verification processes, ensuring adherence to CarePal's pricing agreements.
- Lead efforts to streamline billing accuracy, end-to-end claim processing, optimize reconciliation processes, and enhance the patient experience.
Billing Verification & Reconciliation:
- Conduct cost verification and reconciliation with hospital billing & Finance teams to prevent discrepancies and ensure adherence to agreed rates.
- Develop structured reconciliation processes to accurately track and validate patient costs.
- Identify opportunities for cost-saving and process improvement in billing workflows.
Patient Journey & Health Insurance Coordination:
- Oversee the full patient journey from admission through discharge, ensuring compliance with healthcare insurance guidelines.
- Coordinate with TPA and hospital teams for seamless admission, discharge, and insurance claim processes.
- Ensure all insurance-related processes are efficient, accurate, and meet regulatory standards.
Expected Salary: $120,000 - $180,000 per year
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