Job Description
Job Summary
The Insurance Manager is responsible for overseeing and managing all aspects of the insurance and claims processing operations within the Revenue Cycle Management (RCM) department. This role involves ensuring timely submission, follow-up, and resubmission of claims to maximize reimbursement rates, minimize denials, and improve cash flow. The Insurance Manager will also collaborate closely with clinical, financial, and administrative teams to optimize processes and ensure regulatory compliance.
Key Responsibilities
- Claims Management
- Supervise and manage the entire claim life cycle, including claim preparation, submission, follow-up, resubmission, and appeals.
- Develop and implement procedures to minimize claim denials and reduce the claim processing timeline.
- Ensure accurate coding and compliance with payer requirements to increase the likelihood of first-pass approval.
- Revenue Cycle Optimization
- Monitor revenue cycle metrics to identify bottlenecks, optimize workflows, and improve overall efficiency.
- Track and analyze key performance indicators (KPIs) such as Days in Accounts Receivable (AR), denial rates, and clean claim percentages.
- Lead initiatives to streamline the insurance and billing process, resulting in improved cash flow and financial performance.
- Denial Management and Resubmissions
- Oversee denial management processes, including root cause analysis, corrective actions, and documentation improvements.
- Ensure that denied claims are reviewed, appealed, and resubmitted in a timely manner.
- Work with the billing and coding teams to address patterns in denials and implement solutions to minimize their recurrence.
- Compliance and Quality Assurance
- Maintain up-to-date knowledge of payer policies, insurance regulations, and RCM best practices.
- Conduct regular audits of insurance claims, submission processes, and resubmission protocols to ensure compliance and accuracy.
- Ensure the team adheres to all regulatory and organizational standards, including HIPAA and other relevant guidelines.
- Staff Management and Training
- Hire, train, and manage a team of insurance and billing specialists, providing guidance on claim handling, RCM procedures, and compliance.
- Develop ongoing training programs to keep staff updated on changes in payer rules, coding guidelines, and RCM technologies.
- Conduct performance reviews, set goals, and provide feedback to enhance team productivity and efficiency.
- Stakeholder Collaboration
- Work closely with clinical staff, physicians, and other departments to address claim-related issues and streamline documentation requirements.
- Coordinate with IT and finance teams to ensure seamless integration of billing software and reporting tools.
- Collaborate with external insurance representatives to negotiate contracts, resolve claim issues, and discuss trends affecting claim approvals.
Qualifications
- Bachelor’s degree in Healthcare Administration, Business, Finance, or related field; Master’s degree preferred.
- Minimum 5 years of experience in insurance management, RCM, or healthcare billing, with a focus on claim submission and denial management.
- Strong knowledge of healthcare billing processes, payer regulations, and coding (CPT, ICD-10).
- Proficiency in RCM software and electronic health record (EHR) systems (e.g., EPIC, Cerner).
- Excellent analytical, problem-solving, and decision-making skills.
- Strong leadership and team management abilities.
How to Apply:
Please submit your CV and a cover letter detailing your experience and suitability for the role to Insurance Manager email Type: Full-time
