Insurance Manager-(Health Care)

The Insurance Manager in a healthcare setting is responsible for overseeing the management of medical insurance policies, claims, and compliance with industry regulations. This role ensures that the healthcare facility is properly reimbursed for services while maintaining strong relationships with insurance providers. The Insurance Manager works closely with finance, billing, and patient services teams to streamline processes, reduce claim denials, and enhance overall efficiency in insurance operations. Strong analytical, negotiation, and leadership skills are essential for success in this role.

Responsibilities:

• Develop and implement policies for managing healthcare insurance claims and reimbursements.

• Oversee the processing of medical claims to ensure accuracy and timely submissions.

• Negotiate contracts and reimbursement rates with insurance providers and third-party payers.

• Ensure compliance with healthcare insurance regulations and industry standards.

• Monitor claim denials and implement strategies to improve claim acceptance rates.

• Work closely with the finance and billing departments to optimize revenue cycle management.

• Analyze insurance trends and provide reports to senior management for decision-making.

• Educate staff and healthcare providers on insurance policies and claim submission processes.

• Handle patient inquiries related to insurance coverage, claims, and billing disputes.

• Stay updated on regulatory changes, new healthcare policies, and industry best practices.

Requirements:

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

• Proven experience in healthcare insurance management, medical billing, or revenue cycle management.

• Strong knowledge of healthcare insurance policies, claims processing, and industry regulations.

• Proficiency in medical coding systems (ICD, CPT) and electronic health records (EHR) software.

• Excellent negotiation, analytical, and problem-solving skills.

• Ability to manage multiple tasks and work under pressure in a fast-paced environment.

• Strong leadership and team management abilities.

• Exceptional communication skills to interact with insurance providers, healthcare professionals, and patients.