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1 - 4 years

1 - 4 Lacs

Posted:1 day ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

The selected candidate willbe responsible for managing the approval and rejection processes for cashlessclaims under TPA and MJPJAY schemes. This will involve close coordination withhospital doctors, wards, the billing team, and insurance companies.
Key Responsibilities:
  • Handle approval and rejection of cases within the TPA department.
  • Coordinate with hospital doctors and wards to ensure the availability of cashless facilities for patients.
  • Manage pre-authorizations, patient admissions, and discharges, especially in the absence of the respective TPA/MJPJAY team member.
  • Collaborate with the in-house ward, ICU, IPCU, and billing team to ensure final cashless approval for patients.
  • Resolve issues related to cashless claims with TPA/MJPJAY authorities.
  • Coordinate with TPA and insurance companies for approvals, rejections, or queries related to cashless cases.
  • Prepare daily MIS reports for cashless cases.
  • Be well-versed with TPA and MJPJAY portals for smooth processing.
  • Settle cashless cases on the HMIS portal.
  • Prepare refund sheets for cashless deposit refunds.
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