4 Claims Resolution Jobs

JOB DESCRIPTION : HOSPITAL RELATIONS MANAGER Department: Hospital Relations Location: Hyderabad,Warangal,Nizamabad,Vijaywada,Visakhapatnam Job Type: Full-Time Job Summary: The Hospital Relations Manager will be responsible for managing and optimizing the relationship between the organization and hospital partners. This role involves overseeing pricing strategies, negotiating claims, resolving pending issues, and ensuring smooth coordination with internal stakeholders. The position also requires meticulous documentation related to training, meetings with internal and external stakeholders and updates to facilitate effective communication and decision-making. Key Responsibilities: 1. Hospital Visit Management: Conduct regular visits to hospital partners to review and address pricing structures, contract terms, and service quality. Analyze and assess hospital billing and pricing strategies to ensure alignment with organizational objectives. 2. Claims Negotiation: Lead negotiations with hospital partners regarding claims and reimbursement issues to ensure favorable outcomes for the organization. Work closely with the internal claims team to resolve discrepancies and expedite claim resolutions. 4. Pending Issues and Concerns: Identify, track, and resolve pending issues and concerns related to hospital partnerships, including billing disputes, service quality, and contractual obligations. Act as a liaison between the hospital and internal teams to address and mitigate concerns promptly. 5. Coordination with Internal Stakeholders: Collaborate with internal departments to ensure alignment on hospital-related activities and strategies. Facilitate effective communication and coordination between internal teams to address issues and implement solutions. 6. Documentation and Reporting: Prepare and maintain comprehensive documentation of hospital visits, pricing agreements, claims negotiations, and issue resolutions. Document and update sales meetings, including key takeaways, action items, and progress reports. 7. Sales Meeting Coordination: Organize and lead sales meetings to discuss hospital partnerships. Provide regular updates and reports to sales teams and management on hospital-related activities and performance. Qualifications: Education: Any Medical Background Minimum of 3 years of experience in hospital relations,Provider Management, healthcare finance, or a similar role. Strong negotiation skills with a proven track record of successful claims resolution. Excellent communication and interpersonal skills to effectively interact with hospital partners and internal teams. Proficiency in Excel, PowerPoint, MS Word. Ability to handle complex issues and provide strategic solutions in a fast-paced environment. Preferred Skills: Experience with hospital billing systems and healthcare reimbursement processes. Knowledge of insurance industry regulations and compliance requirements. Working Conditions: Outdoor visits to hospitals. Flexibility to work outside regular office hours as needed for urgent issues or meetings.

Review and follow up on hospital billing claims for US healthcare providers Understand insurance denials, EOBs, and remittance advice for claim resolution Initiate outbound calls to insurance co Handle denials, underpayments, rejections effectively Required Candidate profile Hands-on exp in AR Calling Hospital Billing domain (US Healthcare). Knowledge of insurance follow-up, CPT/ICD codes, and claim lifecycle Strong understanding of revenue cycle management Excellent comm Perks and benefits Perks and Benefits

JOB DESCRIPTION HOSPITAL RELATIONS MANAGER Job Title: Chief Manager Department: Hospital Relations Location: Pune, Pimpri, Nagpur, Nashik, Kolhapur, Solapur, Aurangabad Job Type: Full-Time Job Summary: The Hospital Relations Manager will be responsible for managing and optimizing the relationship between the organization and hospital partners. This role involves overseeing pricing strategies, negotiating claims, resolving pending issues, and ensuring smooth coordination with internal stakeholders. The position also requires meticulous documentation related to training, meetings with internal and external stakeholders and updates to facilitate effective communication and decision-making. Key Responsibilities: 1. Hospital Visit Management: Conduct regular visits to hospital partners to review and address pricing structures, contract terms, and service quality. Analyze and assess hospital billing and pricing strategies to ensure alignment with organizational objectives. 2. Claims Negotiation: Lead negotiations with hospital partners regarding claims and reimbursement issues to ensure favorable outcomes for the organization. Work closely with the internal claims team to resolve discrepancies and expedite claim resolutions. 4. Pending Issues and Concerns: Identify, track, and resolve pending issues and concerns related to hospital partnerships, including billing disputes, service quality, and contractual obligations. Act as a liaison between the hospital and internal teams to address and mitigate concerns promptly. 5. Coordination with Internal Stakeholders: Collaborate with internal departments to ensure alignment on hospital-related activities and strategies. Facilitate effective communication and coordination between internal teams to address issues and implement solutions. 6. Documentation and Reporting: Prepare and maintain comprehensive documentation of hospital visits, pricing agreements, claims negotiations, and issue resolutions. Document and update sales meetings, including key takeaways, action items, and progress reports. 7. Sales Meeting Coordination: Organize and lead sales meetings to discuss hospital partnerships. Provide regular updates and reports to sales teams and management on hospital-related activities and performance. Qualifications: Bachelors degree in Business Administration, Healthcare Management, Doctor Minimum of 10 years of experience in hospital relations,Provider Management, healthcare finance, or a similar role. Strong negotiation skills with a proven track record of successful claims resolution. Excellent communication and interpersonal skills to effectively interact with hospital partners and internal teams. Proficiency in Excel, PowerPoint, MS Word. Ability to handle complex issues and provide strategic solutions in a fast-paced environment. Preferred Skills: Experience with hospital billing systems and healthcare reimbursement processes. Knowledge of insurance industry regulations and compliance requirements. Working Conditions: Outdoor visits to hospitals. Flexibility to work outside regular office hours as needed for urgent issues or meetings.

Problem solving skills to resolve complex customer inquiries. Demonstrated ability to improve and/or transform team processes. Ability to adapt to changes quickly and think conceptually Billing and resubmitting claims Retrieving necessary documents for billing and account resolution Posting adjustments and resolving credit balances Resolving rejections and denials through corrections and appeals