Insurance Executive

4 days ago

Hyderabad, Telangana, India AKIRA Advisors LLP Full time ₹ 15,00,000 - ₹ 28,00,000 per year

Job Summary:

The Hospital Insurance Coordinator with Accounting responsibilities is responsible for managing all aspects of the hospital's insurance claims process, while also overseeing the financial accounting related to insurance billing, payments, and reconciliations. This role involves collaborating with insurance companies, TPAs (Third Party Administrators), and patients to ensure accurate and timely submission of claims while maintaining precise accounting records of insurance-related transactions.

Key Responsibilities:

1.Insurance Coordination:

Insurance Verification:

·      Verify patient insurance coverage, eligibility, and pre-authorization requirements.

·      Communicate with insurance companies to confirm coverage details, limits, and exclusions.

·      Assist patients in understanding their insurance coverage, co-pays, deductibles, and out-of-pocket expenses.

·      Provide support in completing reimbursement claims, if applicable.

Claims Processing:

·      Prepare, submit, and follow up on insurance claims to ensure timely payments.

·      Address claim rejections or discrepancies by liaising with insurance providers and resolving any issues.

·      Maintain proper documentation for all insurance claims, including pre-authorization forms, discharge summaries, and treatment reports.

Empanelment and Network Coordination:

·      Manage empanelment with insurance providers, and TPAs.

·      Maintain up-to-date contracts and agreements with various insurance partners and ensure compliance with their policies.

2. Accounting & Reporting Responsibilities:

Billing and Reconciliation:

·      Ensure accurate billing of insurance claims, including preparing itemized bills and coding procedures correctly.

·      Reconcile payments received from insurance companies with submitted claims and hospital financial records.

·      Track all outstanding claims and unpaid invoices, ensuring timely follow-up on pending payments.

·      Prepare and update patient billing records for outstanding amounts post-insurance coverage.

·      Reconcile any discrepancies between billed amounts and received payments, identifying and addressing underpayments or overpayments.

·      Prepare regular reports for management on claims status, payment collections, outstanding receivables, and other key financial metrics related to insurance.

·      Audit and Compliance:

3. Collaboration:

Internal Coordination:

·      Work closely with the hospital billing team, finance department, and medical staff to ensure accurate claim submissions and payment processing.

·      Coordinate with the finance team for monthly and annual closing processes, ensuring all insurance-related transactions are recorded correctly.

External Coordination:

·      Communicate with insurance companies and TPAs to resolve issues related to claim processing, payments, and policy compliance.

·      Coordinate with auditors, if necessary, during reviews of insurance-related financial transactions.

Key Skills:

  • Strong knowledge of insurance policies (TPA, private insurance) and accounting principles.
  • Attention to detail and high accuracy in financial record-keeping.
  • Excellent communication and negotiation skills to handle patient inquiries and insurance disputes.
  • Ability to work with numbers and handle large volumes of financial data efficiently.
  • Proficiency in Microsoft Excel, financial software, and hospital management systems.
  • Problem-solving skills with the ability to address discrepancies in claims and payments.

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