The Insurance Coordinator is responsible for coordinating cashless hospitalization, insurance approvals, claims processing, and communication with insurance companies, TPAs, patients, and clinical departments. The role ensures timely authorization, accurate documentation, claim submission, and compliance with hospital policies and insurance guidelines to facilitate seamless patient care and revenue realization.
Key Responsibilities
- Coordinate cashless admission and obtain pre-authorizations from insurance companies and TPAs.
- Verify patient insurance eligibility, coverage, and policy benefits.
- Prepare and submit pre-authorization requests with complete clinical documentation.
- Follow up with insurers and TPAs for approvals, enhancements, and claim status.
- Coordinate with doctors, nursing staff, billing, and medical records for required documents.
- Ensure accurate preparation and timely submission of final claims.
- Resolve insurance claim queries, deficiencies, deductions, and rejections.
- Maintain proper records of approvals, claim submissions, settlements, and outstanding claims.
- Educate patients and attendants regarding insurance procedures, coverage, exclusions, and required documents.
- Ensure compliance with NABH standards, hospital policies, and insurance regulations.
- Monitor turnaround time (TAT) for approvals and claim settlements.
- Prepare daily, weekly, and monthly MIS reports related to insurance activities.
- Coordinate with finance for reconciliation of insurance payments.
- Maintain confidentiality of patient information and insurance records.
- Participate in quality improvement initiatives and departmental audits.
Qualifications
- Bachelor's Degree in Hospital Administration, Commerce, Business Administration, or related field.
- Certification in Health Insurance or Hospital Administration is desirable.
Experience
- 2–5 years of experience in hospital insurance coordination, TPA handling, or medical billing.
- Experience in a multispecialty hospital is preferred.
Skills & Competencies
- Knowledge of health insurance policies, TPAs, and cashless processes.
- Understanding of medical terminology and hospital billing.
- Excellent communication and interpersonal skills.
- Strong documentation and organizational skills.
- Proficiency in Hospital Information Systems (HIS) and Microsoft Office.
- Analytical and problem-solving abilities.
- Attention to detail and accuracy.
- Ability to work under pressure and meet deadlines.
- Customer-focused approach.
- High ethical standards and confidentiality.
Pay: ₹8,086.00 - ₹20,413.41 per month
Benefits:
Work Location: In person
