Key Responsibilities1. Patient Registration & Eligibility Verification
- Verify beneficiary eligibility through the Ayushman Bharat portal.
- Ensure Aadhaar, Ayushman Card, and other identity documents are valid.
- Assist patients with beneficiary verification and pre-authorization requirements.
- Coordinate with the Ayushman Mitra for smooth patient registration.
2. Pre-Authorization
- Prepare and submit pre-authorization requests as per package guidelines.
- Coordinate with treating consultants for clinical documentation.
- Follow up with the State Health Agency (SHA)/Insurance Company for timely approvals.
- Ensure all required approvals are obtained before treatment whenever applicable.
3. Billing & Package Management
- Prepare bills strictly according to approved AB-PMJAY package rates.
- Ensure correct package selection and coding.
- Verify all investigations, implants, consumables, and procedures are billed as per scheme guidelines.
- Prevent duplicate or non-permissible billing.
4. Claim Preparation & Submission
- Compile complete claim files with all mandatory supporting documents.
- Upload claims on the BIS/TMS portal within the prescribed timelines.
- Ensure claims are complete, accurate, and compliant before submission.
- Maintain records of submitted claims and acknowledgements.
5. Claim Follow-up & Settlement
- Track claim status on the portal.
- Follow up for pending approvals and claim settlements.
- Resolve deficiencies, objections, and query cases promptly.
- Coordinate with insurance companies, TPAs, and State Health Agency officials for claim resolution.
6. Documentation & Compliance
- Ensure all clinical and billing documents are complete and properly signed.
- Maintain physical and electronic claim records.
- Ensure compliance with National Health Authority (NHA) and State Health Agency guidelines.
- Stay updated on revised package rates, circulars, and operational guidelines.
7. Coordination
- Coordinate with:
- Treating Consultants
- Nursing Department
- Medical Records Department (MRD)
- Pharmacy
- Diagnostics
- Finance Department
- Ayushman Mitra
- Insurance Companies/TPAs
- State Health Agency (SHA)
8. MIS & Reporting
- Prepare daily, weekly, and monthly MIS reports covering:
- Patient registrations
- Pre-authorizations
- Claims submitted
- Claims approved/rejected
- Pending claims
- Deficiency cases
- Payments received
- Outstanding receivables
9. Audit Support
- Provide claim documents during internal and external audits.
- Ensure compliance during NHA, SHA, insurance, and hospital audits.
- Assist in corrective actions for audit observations.
Pay: ₹20,000.00 - ₹38,000.00 per month
Benefits:
- Cell phone reimbursement
- Flexible schedule
Work Location: In person
