- Beneficiary identification and verification:
- Use the Beneficiary Identification System (BIS) and other relevant databases (SECC, RSBY, State Health Scheme) to check if a patient is eligible for the scheme.
- Verify the patient's identity using an Aadhaar card or other government-approved ID, and confirm family details via a ration card or PMJAY ID.
- Pre-authorization and treatment:
- Prepare and submit a request for pre-authorization to the State Health Agency (SHA) or insurance company for planned medical procedures and diagnostics.
- Coordinate with the hospital's medical team to gather the necessary documentation for the treatment package.
- Claims management and billing:
- Capture and record patient data on admission, treatment, and discharge using the Transaction Management System (TMS).
- Process and generate the final patient bill according to the PMJAY-mandated packages and rates.
- Ensure all necessary clinical notes, diagnostic reports, and discharge summaries are collected for claim submission.
- Submit the claim on the official portal within 24 hours of the patient's discharge.
- Patient support and coordination:
- Act as a key contact point for PMJAY beneficiaries, guiding them through the registration and claims process.
- Serve at the hospital's Ayushman Bharat kiosk to provide assistance and information to patients and their families.
- Compliance and reporting:
- Ensure all billing and claims activities are compliant with National Health Authority (NHA) guidelines.
- Prevent and identify fraudulent or erroneous claims.
- Help maintain accurate records and generate management information system (MIS) reports as required.
Job Type: Full-time
Pay: ₹10,000.00 - ₹25,000.00 per month
Work Location: In person
