Manager - Billing and Claims at Bliss Healthcare

Job Purpose

• Responsible for overseeing all billing and claims operations across Bliss Healthcare Limited to ensure accurate, timely, and compliant invoice verification, claims submission, recon- ciliation, and reporting.
• This role drives revenue cycle efficiency, minimizes deduc- tions, ensures adherence to payer requirements, and leads the billing & claims team to achieve set KPIs.

Key Responsibilities

• Lead and supervise all billing and claims activities to ensure 100% invoice receipt, verification, and error-free claim submission.
• Oversee invoice checks to confirm:
• Invoice number matches smart, Slade, or m-Tiba report. Member number matches across reports and invoice. Amount matches report totals. Correct claim form is used.
• Dates and patient names match across all documents. Ensure 100% reconciliation of all insurance accounts.
• Monitor and achieve KPI targets for the team
• 95% account sign-off by revenue.
• <1% deduction rate.
• Monitor timely submissions from unit HQ payer.
• Ensure all visits are Smarted/LCT and all documents uploaded on Slade.
• Develop, maintain, and implement billing SOPs in alignment with payer requirements.
• Provide regular training to team members and medical center staff on scheme changes and claims processes. Ensure communication of pending and queried billings to insurers and relevant teams promptly.
• Submit accurate and timely reports, including real-time system updates with IT teams.
• Collaborate with operations, finance, and clinical teams to resolve claim disputes, rejections, and delayed payments. Ensure timely statement generation and submission to insurers.
• Lead initiatives to improve clean claim rates and reduce processing delays.
• Any other duties assigned by the supervisor(s).

Job Requirements

Minimum Qualifications

• Bachelor's degree in Finance, Accounting, Healthcare Administration, or related field.

Experience

• Minimum 5 years' experience in healthcare billing and claims, with at least 2 years in a supervisory role.
• Strong knowledge of medical billing systems (e.g., Slade, m-Tiba) and payer claim processes.
• Experience in hospital or clinical revenue cycle management added advantage.