Handle
patient billing
for OPD, IPD, daycare, and emergency cases as per hospital policy.
Process and manage
TPA / Insurance and Ayushman Bharat (PM-JAY) government scheme
cases, including cashless and reimbursement, from admission to final settlement.
Verify
insurance/Ayushman eligibility, policy coverage, and authorization approvals
with TPAs, insurance companies, and government portals.
Prepare and submit
pre-authorization, enhancement requests, and final bills
within defined timelines.
Coordinate with doctors, nursing staff, and other departments to ensure
accurate billing and complete documentation
.
Ensure
coding accuracy
as per approved tariff, packages, TPA agreements, and
Ayushman package guidelines
.
Follow up with
TPAs, insurance companies, and government agencies
for claim approvals, payments, and pending queries.
Maintain proper
records, MIS reports, and claim trackers
for TPA, insurance, and Ayushman cases.
Handle
patient and attendant queries
related to billing, insurance, and Ayushman claims in a professional manner.
Ensure compliance with
NABH, IRDAI, Ayushman Bharat guidelines
, and hospital billing policies.
Identify
discrepancies, short payments, or claim rejections
and initiate corrective and appeal actions.
Maintain
strict confidentiality
of patient data, insurance documents, and government scheme records.

Preferred candidate profile

Knowledge of
hospital billing software / HIS
Good understanding of
TPA & Insurance processes
Strong communication and coordination skills
Attention to detail and documentation accuracy

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