Job Description

Beneficiary identification and verification:

Use the Beneficiary Identification System (BIS) and other relevant databases (SECC, RSBY, State Health Scheme) to check if a patient is eligible for the scheme. Verify the patient's identity using an Aadhaar card or other government-approved ID, and confirm family details via a ration card or PMJAY ID.

Pre-authorization and treatment:

Prepare and submit a request for pre-authorization to the State Health Agency (SHA) or insurance company for planned medical procedures and diagnostics. Coordinate with the hospital's medical team to gather the necessary documentation for the treatment package.

Claims management and billing:

Capture and record patient data on admission, treatment, and discharge using the Transaction Management System (TMS). Process and generate the final patient bill according to the PMJAY-mandated packages and rates. Ensure all necessary clinical notes, diagnostic reports, and discharge summaries are collected for claim submission. Submit the claim on the official portal within 24 hours of the patient's discharge.

Patient support and coordination:

Act as a key contact point for PMJAY beneficiaries, guiding them through the registration and claims process. Serve at the hospital's Ayushman Bharat kiosk to provide assistance and information to patients and their families.

Compliance and reporting:

Ensure all billing and claims activities are compliant with National Health Authority (NHA) guidelines. Prevent and identify fraudulent or erroneous claims. Help maintain accurate records and generate management information system (MIS) reports as required.
Job Type: Full-time

Pay: ₹10,000.00 - ₹25,000.00 per month

Work Location: In person