INSURANCE SERVICE MANAGER – Doctors Hospital

INSURANCE SERVICE MANAGER

We are searching for an experienced INSURANCE SERVICE MANAGER at our DHB PATIENT FINANCE facility.

Primary Duties and Responsibilities: 

The Insurance Services Manager provides strategic and operational leadership for the Insurance Services Department. This role is responsible for ensuring timely and accurate claims submission, payer compliance, revenue integrity, and optimal reimbursement performance. The manager drives process improvement, oversees team performance, and ensures adherence to regulatory and accreditation standards while supporting the hospital’s financial and service excellence objectives.

Essential Duties:

Leadership & Department Oversight:

• Provide direct leadership and supervision of the Insurance Services team. 
• Establish performance expectations, KPIs, and accountability measures. 
• Conduct monthly departmental meetings to review performance metrics and payer trends. 
• Maintain proactive communication across Patient Finance, Billing, Coding, and Clinical teams. 
• Lead customer service initiatives to ensure a positive patient experience. 

Revenue Cycle & Claims Management:

• Oversee accurate and timely submission of all insurance claims. 
• Ensure compliance with ICD-10, CPT, HCPCS, and revenue coding standards. 
• Monitor outstanding claims and maintain aging within target thresholds. 
• Ensure follow-up on unpaid claims beginning at 30 days post-dispatch. 
• Analyze denial trends and implement corrective action plans. 
• Improve clean claim rate and reduce AR days. 

Financial Stewardship:

• Assist in the development and management of the department’s annual budget. 
• Monitor receivables and deposit/copay collection processes. 
• Identify policy gaps impacting reimbursement and implement improvements. 
• Partner with senior leadership to improve cash acceleration and payer performance. 

Compliance & Quality:

• Develop and revise departmental policies in alignment with regulatory standards. 
• Ensure compliance with government regulations and accreditation standards. 
• Conduct internal audits to validate accuracy and adherence to policy. 
• Lead performance improvement initiatives using data analytics. 

 

Required Qualifications:

 

 

Education:

• Bachelor’s Degree in Business Administration, Health Administration, or related field required. 
• CPC Certification is required. 
• Strong knowledge of ICD-10, CPT, HCPCS, Revenue Codes, and medical terminology. 
• Minimum 3–5 years of progressive healthcare claims and revenue cycle experience.
• Demonstrated leadership and team management experience. 

 

Certification:
The incumbent must be certified in healthcare billing and coding, preferably with a certification from a recognized professional association such as the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).
The Insurance Services Manager at Doctors Hospital Health System is a critical role responsible for managing the daily operations of the Insurance Services Department within the Patient Finance Department. The incumbent must possess significant experience in healthcare insurance billing and reimbursement practices, as well as strong leadership and organizational skills. The role offers a challenging and rewarding opportunity to make a meaningful impact on the healthcare experience of patients and their families.

Experience:

• The incumbent must have a minimum of 5 to 8 years of relevant experience in insurance services management, preferably in a healthcare setting. 

Knowledge:

• The incumbent must have a thorough understanding of insurance billing and reimbursement practices, as well as knowledge of current laws and regulations governing healthcare billing.
  

Skills:

• The Insurance Services Manager must have excellent leadership, communication, and organizational skills. The incumbent must also possess strong analytical and problem-solving skills, as well as the ability to manage multiple priorities simultaneously. The ability to work effectively with others as part of a team is essential, as is the ability to build and maintain positive relationships with patients, insurance companies, and other stakeholders.

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