Job Summary The Ayushman Operator is responsible for end-to-end management of Ayushman Bharat (PM-JAY) and other government health scheme cases, ensuring timely patient registration, pre-authorisation, claim submission, documentation, and coordination with doctors, billing, nursing, and insurance authorities. Key Responsibilities Patient Registration Verify patient eligibility under PM-JAY. Generate Ayushman card (where applicable). Register eligible patients on the PM-JAY portal. Explain scheme benefits and required documents to patients. Pre-Authorisation Prepare and upload complete clinical documents. Coordinate with consultants for diagnosis, treatment plan, and supporting records. Submit pre-authorisation requests within prescribed timelines. Follow up for approvals. Documentation Maintain complete patient files. Ensure all consent forms, investigation reports, operative notes, discharge summaries, and prescriptions are properly documented. Verify completeness before claim submission. Claim Processing Submit final claims accurately. Respond to insurer/TPA queries promptly. Track pending claims and rejections. Coordinate corrections and resubmissions. Coordination Work closely with: Doctors Billing department Medical Records Department (MRD) Nursing staff Ayushman authorities TPAs Reporting Daily admitted cases. Daily approvals. Pending pre-authorisations. Pending claims. Rejected claims. Monthly revenue under Ayushman. Eligibility Graduate in any discipline. Experience with PM-JAY or government health schemes preferred. Knowledge of hospital billing and medical terminology. Good computer skills. Familiarity with MS Excel and hospital software. Skills Required Attention to detail. Documentation accuracy. Communication skills. Time management. Ability to work under pressure. Basic understanding of medical records. Preferred Experience 1–3 years in Ayushman Bharat/TPA operations. Experience in NABH-accredited hospitals is an advantage. Key Performance Indicators (KPIs) Pre-authorisation turnaround time. Claim submission within 24–48 hours of discharge. Claim approval percentage. Rejection rate. Documentation accuracy. Average claim processing time. Number of pending claims older than 15 days.
Job Type: Full-time
Pay: ₹14,000.00 - ₹20,000.00 per month
Benefits:
Work Location: In person
