Job Title
ECHS Executive
Department
BILLING / Corporate & Government Health Schemes
Reports To
Manager – BILLING / Medical Billing Manager / Hospital Administrator
Position Summary
The ECHS Executive is responsible for managing all activities related to ECHS beneficiaries, including patient registration, eligibility verification, pre-authorization, documentation, billing, claim submission, follow-up, and coordination with ECHS Polyclinics and Regional Centres. The role ensures timely processing of cashless treatments and compliance with ECHS guidelines.
Key Responsibilities
Patient Registration & Verification
- Verify ECHS smart cards and beneficiary eligibility.
- Register ECHS patients in the Hospital Information System (HIS).
- Guide patients and attendants regarding admission procedures and required documentation.
- Ensure all mandatory documents are complete before admission.
Admission & Pre-Authorization
- Coordinate with the ECHS Polyclinic for referral verification.
- Process pre-authorization requests as per ECHS guidelines.
- Obtain approvals for admissions, surgeries, investigations, and procedures.
- Maintain records of all approvals and correspondence.
Documentation
- Collect and verify all required documents, including:
- ECHS Smart Card
- Referral Letter
- Aadhaar Card (where applicable)
- Investigation Reports
- Consent Forms
- Discharge Summary
- Bills and Supporting Documents
- Ensure documentation is complete and audit-ready.
Billing & Claim Processing
- Prepare accurate bills according to ECHS package rates.
- Ensure all consumables, procedures, and investigations are billed correctly.
- Submit claims within prescribed timelines.
- Maintain claim submission records and acknowledgment receipts.
- Follow up on pending claims and payment status.
Coordination
- Liaise with ECHS Polyclinics, Regional Centres, hospital departments, consultants, and the finance team.
- Coordinate with doctors for required medical documents and clinical justifications.
- Resolve patient and departmental queries related to ECHS services.
Record Maintenance
- Maintain daily records of admissions, discharges, pending approvals, submitted claims, and rejected claims.
- Generate periodic MIS reports for management.
- Maintain confidentiality of patient information.
Compliance
- Ensure adherence to ECHS policies, package rates, and government regulations.
- Prepare records for internal and external audits.
- Assist during inspections by ECHS authorities.
Patient Service
- Provide courteous assistance to ECHS beneficiaries and their attendants.
- Explain treatment processes, documentation requirements, and discharge formalities.
- Address complaints professionally and ensure patient satisfaction.
Qualification
- Graduate in any discipline (Bachelor's Degree mandatory).
- Preference will be given to candidates with a degree in Hospital Administration, Healthcare Management, B.Com, BBA, or related fields.
Experience
- 2–5 years of experience in ECHS, CGHS, or government healthcare claim processing.
- Experience in a NABH-accredited hospital is preferred.
Knowledge & Skills
- Thorough knowledge of ECHS policies, referrals, and package rates.
- Familiarity with CGHS and other government health schemes is desirable.
- Knowledge of Hospital Information Systems (HIS).
- Strong documentation and claim management skills.
- Excellent communication and interpersonal skills.
- Good computer proficiency, including MS Office (Word, Excel, Outlook).
- Ability to work under pressure and meet deadlines.
- Strong organizational and coordination skills.
Key Performance Indicators (KPIs)
- Timely processing of ECHS admissions.
- Accuracy of documentation and billing.
- Claim submission within prescribed timelines.
- Low claim rejection percentage.
- Timely resolution of pending claims.
- Compliance with ECHS guidelines.
- Patient satisfaction.
- Timely MIS reporting.
Pay: ₹10,090.36 - ₹22,474.98 per month
Work Location: In person
