Rajesh Kumar

• Ensuring proper functioning and timely flow of reports for billing and recoveries.
• Controlling pricing, packages, and offers to enhance client satisfaction and address concerns.
• Coordinating with various departments such as Medical, Paramedical, Public Relation, and Marketing to foster relations with organizations and insurance companies.
• Managing credit deductions, follow-up, and query management for different entities like TPAs, corporate, PSUs, CGHS, and ECHS. Enhancing efficiency by optimizing, standardizing, and automating front and back-office operations.
• Training team members on new tariffs, policies, communication, and grooming standards. Supported the billing team in resolving concerns and requests related to the HIS and providing training to billing spokes and users.
• Assisting in the implementation of Hospital Information System (HIS) software Pricing management in HIS and creation/mapping of MDM (Master Data Management) service items. Optimizing and standardizing billing processes and policies during company transition phase
• Managing complete hospital tariffs and ensuring successful implementation in HIS, followed by periodic validation.
• Responsible to maintain various service excellence parameters, i.e. Patient satisfaction scores, NPS scores, Process and quality scores.

• Heading Admission & Billing department
• Looking after Cash and Corporate/CGHS/PSU/ECHS Billing
• Customer Management Complaint Management Patient Conversion Other responsibilities - Training of Billing (Cash/ Credit), Process review, Roster Planning, Duty allocation, maintaining the service standards
• Auditing of discharge IPD bills from all aspects, ensuring no revenue leakage
• Satisfactory audit rating during my tenure with the organization
• Deduction analysis
• Ensure discount matrix is followed and discount forms being signed and passed in the system on daily basis and document to be filed for future audit
• Understanding of Non-Medical Expenses, else should be able to bifurcate manually where needed
• Ensure smooth administration to delivery good quality and timely in-patient, ensure error free billing transaction
• Help treating doctor to understand the costing involved, packages, intention of queries raised by TPA/Insurance, necessary documents, medical justifications, PED, NMEs, Propionate deduction, sum insured, individual policy health insurance coverage limitations etc
• Enhances patient care delivery by maintaining a good relationship with the consultants and patient, coordinate with them for all in-patient services by being there one point of contact for all administrative matters, ensure proper escalation of customer grievances, ensure follow ups, introduce continuous improvements to the customer handling system.

• Handling the team –Admission/Counseling, Patient Billing, TPA, And Dispatch for Credit bills
• Overall responsible for entire OPD & IPD operations which consist of Admissions, Emergency & Bed management, Estimate desk, Billing assistance desk, bill settlement desk, TPA operations, Call center, OPD business, bill dispatch
• Analyzing TAT & aLOS & maintaining NPS scores best in class
• OT sheet audit & Daily Billing audit with activity sheet
• Auditing of credit bills as per SOC
• Optimization and standardization of Billing process & Policies
• Maintenance of all records related to corporate approvals, contracts, agreement and reports, daily scrolls and MIS
• Provide functional training to the new staff in the department
• Any other duties assigned by the HOD as per exigencies of work
• Improve efficiency of hospital front and back office operations through optimization, standardization & automation of processes.

• IPD – Billing TPA, Corp, PSU, Cash, ECHS bills preparation
• Responsible for preparing different HIS reports TPA Claim processing & coordinate with TPA for approval
• Auditing of patient files / credit dockets ensuring no revenue leakage during and continuous tracking to reduce the errors
• OT sheet audit daily bill updating Auditing of credit bills as per SOC to trace the discrepancies
• Daily Billing audit with activity sheet.

• Managing & keeping the bill record
• Handling Admission, OPD & IPD billing Update bill on daily basis of IPD patient
• Daily interaction to attendants counselling & update patient/Attendants about their bills & query
• Coordinate with other department for various billing/discharge related query
• Coordinate with TPA’s for cashless process & query reply