· Verification: Review patient health insurance cards and policy documents to verify coverage, limits, and eligibility.
· Pre-authorization: Prepare and submit the initial pre-authorization forms for cashless treatments to the TPA or insurance company.
· Emergency Handling: Prioritize medical emergencies and quickly coordinate with treating consultants to get expedited approvals.
· Patient Guidance: Counsel patients and their families regarding their insurance coverage, co-payments, and any non-medical expenses (deductibles) not covered by their policy.
· Internal Liaison: Act as the central point of contact between ward nurses, resident doctors, and the billing department to track the patient's treatment status.
· Bill Processing: Prepare, verify, and submit the final itemized hospital bills, diagnostic reports, and discharge summaries to the TPA.
· Final Approval: Coordinate with the TPA for the "Final Authorization Letter" so the patient can be discharged without paying the full amount out-of-pocket.
· Reconciliation: Handle split bills and process documentation .
· Submissions: Ensure all physical and digital files are sent securely to the insurance companies on time.
· Follow-Ups: Track pending claims, resolve financial discrepancies, and assist in processing reimbursement claims if cashless approval was denied.
· MIS Reporting: Prepare daily and monthly reports on pending approvals, claim rejections, and overall revenue status.
· Insurance Knowledge: Deep understanding of health insurance policies, TPA guidelines, and healthcare networks.
· Communication: Ability to negotiate and communicate clearly with stressed patients and demanding insurance executives.
· Technical: Proficiency in using hospital management software (HMS) and TPA portals
Pay: ₹18,000.00 - ₹28,000.00 per month
Work Location: In person
