Candidates with experience in hospital field preferred
* Coordinate with insurance companies, TPAs and corporate insurance departments for patient admissions, treatment approvals and claim processing.
* Verify the patient's insurance/TPA eligibility, coverage, policy limits and exclusions.
* Ensure that all required insurance documents are collected and verified at the time of admission.
* Prepare and submit pre-authorization requests with complete medical and financial documents.
* Coordinate with doctors and clinical departments to obtain necessary medical information for approval.
* Follow up with the insurance company/TPA for approval status and communicate the decision to the concerned departments and patient.
* Ensure that additional approvals are obtained whenever there is a change in treatment, procedure or estimated cost.
* Explain the insurance process, coverage limitations, room eligibility, co-payment and non-payable items to patients/attendants.
* Monitor the patient's insurance eligibility throughout the admission.
* Coordinate with billing, nursing, doctors, pharmacy, laboratory and other departments to ensure proper documentation.
* Prepare and submit the final bill and discharge documents to the insurance company/TPA.
* Obtain final discharge authorization/approval wherever required.
* Ensure that the approved amount and patient-payable amount are clearly communicated to the patient.
* Coordinate with billing for settlement of deductibles, exclusions, co-payments and non-payable amounts.
* Submit claims with all required supporting documents within the prescribed *TAT*.
* Track pending claims and follow up regularly with insurance companies/TPAs.
* Respond to queries raised by insurance companies/TPAs and provide additional documents promptly.
Pay: ₹25,000.00 - ₹31,000.00 per month
Work Location: In person
