The Claims Manager is responsible for overseeing the claims management process within the hospital’s Revenue Cycle Management (RCM). This role ensures accurate and timely submission, processing, and resolution of insurance claims to maximize reimbursement while adhering to regulations and maintaining high levels of efficiency.

Responsibilities

Claims Management:

• Oversee the preparation, submission, and tracking of insurance claims to ensure accuracy and timeliness.
• Monitor denied or underpaid claims, analyze root causes, and implement corrective actions to prevent recurring issues.
• Ensure compliance with hospital policies, payer requirements, and relevant regulations.

Revenue Optimization:

• Collaborate with the billing, coding, and finance teams to ensure proper documentation and coding practices.
• Analyze trends in claims submissions and reimbursements to identify opportunities for improvement.
• Prepare reports on key performance indicators (KPIs) such as claim approval rates and collection timelines.

Team Management:

• Lead and supervise the claims processing team, providing guidance, training, and performance evaluations.
• Foster a culture of continuous improvement and accountability within the department.

Stakeholder Coordination:

• Act as the main point of contact between the hospital, insurance companies, and other payers.
• Resolve escalated issues related to claim disputes or delays in reimbursements.
• Provide support and education to clinical and administrative staff on claims processes and documentation standards.

Qualifications

Education: Bachelor’s degree in Healthcare Administration, Business, or a related field (preferred).

Experience: 4–6 years in claims management, revenue cycle management, or a similar role within a hospital or insurance company.

Skills:

• Strong knowledge of insurance claim processing, reimbursement methodologies, and healthcare regulations.
• Excellent analytical and problem-solving skills.
• Strong leadership and team management abilities.
• Proficiency in healthcare billing systems and software.