GROUP HEAD OF CLAIMS & BILLING | DUBLIN | HEALTHCARE

Prism Executive have partnered with a leading health care provider to appoint a Group Head of Claims and Billing. The appointee will be responsible for overseeing the end-to-end management of financial transactions related to patient billing and insurance claims.

This role ensures that accurate financial data is processed from the hospital to health insurers, optimizing people, process, revenue capture, minimizing claim denials, and driving operational efficiencies across a large and complex team.

The position plays a critical role in managing relationships between the hospital network, patients, consultants, and insurers. In parallel, the role is accountable for leading a large team and delivering a strategic transformation of the claims function—leveraging digital tools, automation, and lean process improvements to drive efficiency, reduce denials, and improve cash flow and margin assurance.

Scope of the Role

To lead a best-in-class billing and claims function that ensures timely, accurate, and compliant financial transactions, supporting the sustainability of Mater Private Network while delivering a seamless financial experience for patients and insurers.

This role spans the full claims and billing lifecycle, from patient registration and verification to claim submission, insurer reimbursement, and financial reconciliation.

Duties & Responsibilities 

Leadership & Strategic Oversight

• Lead a large, multi-functional team across billing, patient accounts, insurance claims, and contracts.

• Develop and implement a strategic vision for claims and billing, ensuring alignment with the financial objectives.

• Drive process standardization and efficiency across all sub-departments.

Billing & Patient Accounts Management

• Ensure timely and accurate billing of all patient services across private and public payers.

• Oversee patient account processes, ensuring clarity and accuracy in financial communications with patients.

• Optimize consultant billing workflows to streamline financial transactions and reduce disputes.

• Implement effective credit control measures to manage outstanding patient balances and reduce bad debt.

• Insurance Claims & Revenue Cycle Management

• Oversee the complete claims lifecycle, from verification to insurer payment reconciliation.

• Ensure robust public billing processes to maximize reimbursements from government and statutory bodies.

Contract & System Optimization

• Oversee the management of insurer contracts, ensuring compliance with agreed terms and fee schedules.

• Work with IT and finance teams to implement system improvements that enhance revenue cycle performance.

• Maintain compliance with all healthcare billing regulations, industry standards, and data security requirements.  

Process Improvement & Digital Enablement

• Lead the review and redesign of key processes using Lean methodologies to eliminate inefficiencies, reduce rework, and increase straight-through processing.

• Drive the implementation of new digital claims tools, including automation, electronic claim routing, and data driven decision support.

• Monitor and reduce claims rejection and resubmission rates through root cause analysis and improved documentation practices.

• Collaborate with internal audit, compliance, and external advisors to ensure process controls, fraud detection, and regulatory compliance.

• Lead change management across the team and wider organization to embed new systems, processes, and cultural improvements.

Stakeholder & Insurer Relationship Management

• Act as the primary liaison between the organisation and health insurers, resolving payment disputes and optimizing claims approval rates.

• Collaborate with hospital finance and clinical teams to improve documentation and coding accuracy.

• Develop strong relationships with consultants, ensuring their billing and claims needs are met while maintaining compliance.

Team Management

• Deliver a Best-in-Class Performance Management experience to each of your team members on a minimum 6 monthly basis with clear Annual Goals and Behavioural Targets 

Comply

• Ensure full compliance as per internal guidelines (e.g. Code of Conduct, Quality and H&S) and applicable external regulations and agreements.

Skills & Qualifications 

• Business Degree

• Minimum 5 years of successful experience as Head of Claims & Billing or similar in businesses of sufficient scale and complexity

• Advanced financial modelling and excel skills essential 

• Ability to influence others and work across organisation to deliver financial budgets and reporting with appropriate market insights and commercial analytics

• Ability to distil lots of facts and insights into a story and an effective creator of financial presentations

• Successful experience in driving performance improvement initiatives

• Proven People Leadership skills 

For further information, please contact, Orla Brennan 086 1720090 / orla.brennan@prismexecutive.ie