Key Responsibilities
- Process pre-authorization requests for planned and emergency IP admissions.
- Verify patient insurance eligibility, policy coverage, and cashless benefits.
- Collect and review required documents, including ID proof, insurance card, clinical notes, investigation reports, and doctor's recommendations.
- Prepare and submit pre-authorization requests through insurance portals, emails, or TPA systems.
- Coordinate with treating consultants and nursing teams to obtain required clinical information.
- Follow up with TPAs and insurance companies for timely approval, enhancement, or clarification requests.
- Maintain records of approvals, denials, pending cases, and turnaround times.
- Inform patients and attendants regarding approval status, policy limitations, and non-payable items.
- Coordinate with the IP Billing team for accurate billing and final authorization before discharge.
- Ensure compliance with insurance guidelines, hospital policies, and NABH standards.
- Escalate delayed approvals or disputed cases to the Insurance Manager.
- Prepare daily MIS reports on pre-authorizations, pending approvals, rejections, and enhancements.
Required Skills
- Familiarity with Hospital Information Systems (HIS).
- Good documentation and data management skills.
- Strong communication and coordination abilities.
- Basic MS Office proficiency (Excel, Word, Outlook).
- Ability to work under pressure and meet turnaround timelines.
Pay: ₹17,000.00 - ₹25,000.00 per month
Benefits:
- Food provided
- Health insurance
- Leave encashment
- Paid sick time
- Paid time off
- Provident Fund
Work Location: In person
