Key Responsibilities
Clinical & Documentation Audit
- Audit IPD/OPD files for completeness and accuracy.
- Verify admission notes, consent forms, medication charts, nursing assessments, progress notes, and discharge summaries.
- Ensure proper documentation of procedures, investigations, implants, and consumables.
- Check authentication (signatures, date, time) as per NABH standards.
Billing & Financial Accuracy
- Cross-check billed items with doctor’s orders and nursing records.
- Validate high-value drugs, ICU charges, procedures, and package billing.
- Identify unbilled services or excess billing.
- Ensure final bill accuracy before discharge clearance.
Insurance / TPA Handling
- Scrutinize cashless and reimbursement cases.
- Verify pre-authorization approvals and policy coverage.
- Respond to insurance/TPA queries with clinical justification.
- Work to reduce claim deductions and rejections.
Compliance & Quality
- Ensure documentation compliance as per NABH guidelines.
- Participate in internal audits and external NABH assessments.
- Maintain audit checklists and compliance records.
- Assist in updating billing and documentation SOPs.
Coordination & Reporting
- Coordinate with nursing, consultants, billing, MRD, and pharmacy.
- Maintain daily query tracker and resolution status.
Qualification: BHMS / BAMS / BEMS / BDS
Experience: 2-3 Years experience required.
Job Types: Full-time, Permanent
Pay: ₹20,000.00 - ₹35,000.00 per month
Benefits:
- Health insurance
- Provident Fund
Work Location: In person
