Key Responsibilities1. Pre-Authorization & Verification
- Coverage Checks: Review and validate patient insurance policies to confirm coverage eligibility for planned or emergency hospitalizations.
- Pre-Approval: Submit medical documents, doctor notes, and cost estimates to the insurance company/TPA to secure pre-authorization for cashless treatments.
- Deficiency Clearing: Promptly respond to queries and provide additional clinical information requested by the insurer to prevent authorization delays. [1, 2, 3, 4, 5]
2. Claim Processing & Management
- Portal Management: Update all patient details, treatment statuses, and financial logs on the respective insurance company or TPA portals.
- Discharge Coordination: Guide patients through the discharge process by ensuring all clinical files, lab reports, and split bills are accurately compiled and sent for final claim approval.
- Reimbursement Assistance: Help patients prepare and submit necessary documents for out-of-pocket or reimbursement claims if cashless approval is denied. [1, 2, 3, 4, 5]
3. Billing & Revenue Cycle
- Bill Reconciliation: Collaborate with the hospital billing and nursing teams to reconcile implant costs, pharmacy charges, and doctor fees according to insurance/corporate TPA guidelines.
- Denial Management: Analyze reasons for rejected or partially paid claims, and prepare appeals or resubmit corrected documents to the insurance company. [1, 2, 3]
4. Patient & Stakeholder Communication
- Patient Counseling: Educate patients and their families on their insurance policy limits, co-payments, and non-medical expenses.
- Liaising: Maintain strong communication channels with doctors, hospital management, and external insurance representatives to ensure transparency. [1, 2, 3, 4]
Essential Skills & Qualifications
- Qualifications: Bachelor’s degree in Hospital Administration (BHA), Business Administration (BBA), or a related healthcare management field.
- Insurance Knowledge: Strong understanding of health insurance terminology, IRDAI guidelines, and TPA networks.
- Technical Proficiency: Experience with hospital information systems (HIS), medical billing software, and TPA portals.
- Soft Skills: Exceptional negotiation, conflict resolution, and communication skills to handle stressful patient queries. [1, 2, 3]
Pay: ₹15,000.91 - ₹20,000.00 per month
Benefits:
Work Location: In person
