- Knowledge of MJPJAY/PMJAY packages and guidelines
- Good knowledge of hospital documentation and medical terminology
- Computer and online portal skills
- Knowledge of e-preauthorisation and claim processing
- Good communication and coordination skills
- Ability to work with consultants, patients, hospital staff and insurance/TPA teams
- Attention to documentation and deadlines
- Ability to handle patient grievances professionally
- Patient evaluation: Ensure required investigations and diagnostic tests are provided free of cost and reports are uploaded to the MJPJAY portal.
- OP/IP status: Assess the patient and update whether the case is OPD or IPD.
- Scheme/package verification: Check whether the patient's diagnosis and proposed treatment are covered under an MJPJAY package.
- Admission: Facilitate timely admission of eligible patients.
- Documentation: Upload admission notes, clinical notes, investigation reports, pre-operative and post-operative records.
- Pre-authorisation: Prepare and submit complete e-preauthorisation requests with required documents, photographs and investigation reports.
- Coordination: Coordinate with treating consultants, insurer/TPA doctors and MJPJAY authorities regarding pending or rejected pre-authorisations.
- Daily clinical updates: Maintain and upload pre-operative/post-operative clinical notes as required.
- Surgery/procedure: Ensure treatment is performed according to the applicable medical protocols and MJPJAY package guidelines.
- Photographs: Ensure required pre-operative, post-operative and discharge photographs are captured and uploaded.
- Discharge: Update surgery and discharge details and ensure the patient receives the required discharge summary and follow-up advice.
- Claims: Check that all required documents are complete and submit claims through the online system; follow up on pending technical/financial queries.
- Patient grievances: Attend to MJPJAY beneficiary complaints and coordinate with the concerned authorities for resolution.
- Transportation: Ensure eligible transportation reimbursement is provided at discharge.
- Follow-up: Facilitate free eligible follow-up consultation, investigations and medicines as per MJPJAY guidelines.
- Records/MIS: Maintain accurate online records and provide reports as required by the hospital, insurer and MJPJAY.
Pay: ₹20,000.00 - ₹30,000.00 per month
Benefits:
Work Location: In person
