Head Billing and TPA

WOW Softech; Mumbai; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

WOW Softech in Mumbai is seeking an experienced Billing Operations Manager to oversee end-to-end hospital billing across OPD, IPD, diagnostics and procedures. You will supervise the billing team, ensure accuracy, drive revenue optimisation and coordinate with insurers and TPAs for timely settlements.

The role requires leadership of a billing team, adherence to policies, and a focus on transparent, compliant processes to improve financial outcomes for the hospital.

Qualifications

• Billing accuracy and transparency across OPD, IPD, diagnostic and procedure billing.
• Timeliness of pre-authorisations, approvals and claim submissions; claim settlement turnaround.
• Compliance with hospital policies, insurance guidelines and regulatory requirements.

Responsibilities

• Billing Operations Management: supervise OPD/IPD/diagnostic billing; ensure accuracy and transparency; monitor HIS usage; review final bills.
• TPA & Insurance Management: manage insurance/TPA desk; ensure pre-authorisations; coordinate with TPAs for settlements.
• Policy & Process Implementation: develop and implement billing and insurance policies; standardise billing practices.
• Team Management: lead billing executives, TPA executives and cashiers; provide training; monitor performance.
• Financial Monitoring & Reporting: monitor daily revenue, billing reports, and claims; prepare reports for management.
• Coordination with Hospital Departments: collaborate with doctors, nursing, pharmacy, diagnostics, MRD for accurate billing.
• Patient & Corporate Relations: address patient concerns; manage corporate tie-ups and empanelments; ensure smooth communication with insurers.

Skills

Billing

Operations management

Leadership

Revenue optimisation

Process improvement

Education

Graduation

Job description

Role & responsibilities

1. Billing Operations Management
   • Supervise and manage all OPD, IPD, diagnostic and procedure billing processes.
   • Ensure accuracy and transparency in patient billing.
   • Monitor billing systems and ensure proper use of the Hospital Information System (HIS).
   • Review and approve final bills for discharge patients when required.
2. TPA & Insurance Management
   • Manage the hospitals insurance and TPA desk operations.
   • Ensure timely pre-authorisations, approvals and claim submissions.
   • Coordinate with insurance companies and TPAs for claim settlements.
   • Handle escalations related to claim rejections, delays or disputes.
3. Policy & Process Implementation
   • Develop and implement billing and insurance policies and procedures.
   • Ensure compliance with hospital policies, insurance guidelines and regulatory requirements.
   • Standardise billing practices and package rates for different procedures.
4. Team Management
   • Lead and supervise the billing executives, TPA executives and cashiers.
   • Provide training and guidance on billing procedures, insurance policies and documentation requirements.
   • Monitor staff performance and ensure efficient workflow in the department.
5. Financial Monitoring & Reporting
   • Monitor daily revenue, billing reports and insurance claims status.
   • Analyse billing data and identify areas for improvement or revenue optimisation.
   • Prepare financial and operational reports for hospital management.
6. Coordination with Hospital Departments
   • Coordinate with doctors, nursing staff, pharmacy, diagnostics and MRD for accurate billing and documentation.
   • Ensure all services provided to patients are properly recorded and billed.
7. Patient & Corporate Relations
   • Address patient concerns related to billing and insurance claims.
   • Manage corporate tie‑ups and insurance empanelments.
   • Ensure smooth communication between patients and insurance providers.

Preferred candidate profile

• Any graduate.
• 1015 years of experience in hospital billing and insurance / TPA operations, including leadership of a billing team.
• Experience leading billing executives, TPA executives and cashiers.

• Billing accuracy and transparency across OPD, IPD, diagnostic and procedure billing.
• Timeliness of pre-authorisations, approvals and claim submissions; claim settlement turnaround.
• Claim rejections, delays and disputes resolution and escalation handling.
• Daily revenue, billing and claims reporting; revenue optimisation outcomes.
• Compliance with hospital policies, insurance guidelines and regulatory requirements.
• Team performance, and strength of corporate tie‑ups and insurance empanelments.