About the Job
Key Responsibilities:A. Pre-admission & admission activities:
1. Verify patient insurance coverage, policy details, and empanelment status with the hospital.
2. Coordinate with consultants and billing department to prepare cost estimates.
3. Submit pre-authorization requests to TPAs/insurance portals along with necessary documentation.
4. Follow up for timely approval and communicate authorization details to the patient and relevant departments.
5. Educate patients and their attendants on cashless procedures, exclusions, and co-payment requirements.
B. Inpatient coordination:
1. Liaise with TPAs for enhancement requests during hospitalization.
2. Track approval validity, ensure periodic updates, and manage documentation for extensions.
3. Ensure all treatments and investigations are aligned with TPA approvals and communicated promptly to avoid short settlements.
4. Work closely with nursing stations, consultants, and billing to ensure documentation completeness.
C. Discharge & final billing:
1. Coordinate with the billing team for preparation and verification of the final bill.
2. Submit final bills and discharge summaries to TPAs for final authorization.
3. Obtain discharge approval before patient release and ensure collection of patient portions/co-payments.
4. Maintain discharge clearance documentation as per TPA/hospital policy.
D. Post-discharge claims & settlements:
Compile and verify claim files, ensuring all supporting documents (bills, reports, authorization letters, discharge summaries, etc.) are attached.
Submit claims to respective TPAs/insurance companies within defined timelines.
Track and follow up on claim settlements, rejections, or pending approvals.
Reconcile claim payments with the accounts department and maintain accurate MIS records.
E. Documentation & compliance:
1. Maintain and update TPA records, patient-wise authorization and settlement trackers.
2. Ensure adherence to TPA guidelines, NABH standards, and hospital SOPs.
3. Handle audit queries and provide required data for internal/external reviews.
4. Maintain patient confidentiality and ensure data protection at all times.
Number of Openings
2 openingsPerks of this Jobs
Health insurance
Skills
Attention to Detail, Analytical Thinking, Effective Communication, Customer Support
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