Job Description

: Insurance Co-ordinatorPosition Title:

Insurance Co-ordinator

Department:

Insurance & Billing / Operations

Reports To:

Operations Manager / Hospital Administrator

Employment Type:

Full-Time

Position Summary

The Insurance Co-ordinator will be responsible for managing all insurance-related processes for patients, including pre-authorizations, approvals, documentation, billing coordination, and discharge clearances. The role ensures seamless communication between the hospital, patients, and insurance companies, while maintaining accuracy, compliance, and excellent patient service.

Key Responsibilities1. Pre-Authorization & Approvals

Verify patient insurance coverage and eligibility at the time of admission or prior to procedures. Submit required clinical documents to insurance TPAs/companies for obtaining pre-authorization. Follow up proactively for approvals and update the concerned departments and patients. Ensure accuracy in coding, diagnosis, procedures, and other clinical details submitted for approval.

2. Documentation & Compliance

Maintain updated knowledge of insurance policies, TPA requirements, approval limits, and documentation standards. Ensure all necessary forms (pre-auth, claim forms, undertaking, etc.) are completed and signed appropriately. Coordinate with doctors and nursing teams to collect clinical notes, discharge summaries, and operative details needed for claims. Adhere strictly to NABH, hospital, and insurance compliance standards.

3. Billing & Claims Processing

Coordinate with the billing department to prepare estimated bills for insurance patients. Reconcile approvals with final billing to avoid discrepancies. Ensure timely submission of final claim documents and bills to the insurance providers. Resolve queries raised by TPAs/insurance companies and ensure smooth claim settlement.

4. Patient Coordination & Communication

Communicate insurance coverage, approval status, exclusions, and out-of-pocket expenses clearly to patients and families. Address patient concerns politely and professionally, ensuring transparency and comfort throughout their hospital journey. Assist patients with insurance forms and explain necessary documentation.

5. Discharge Coordination

Ensure final bill approvals and clearances are obtained on time to avoid discharge delays. Coordinate with the medical, nursing, and billing teams to ensure proper discharge workflow. Manage last-minute insurance queries efficiently for smooth patient exit.

6. Operational & Administrative Support

Maintain accurate records and logs for all insurance patients. Prepare daily/weekly MIS reports on admissions, approvals, and pending claims. Build and maintain relationships with TPA representatives and insurance desk personnel. Assist in internal audits, quality checks, and departmental meetings.

Qualifications & Requirements

Graduate (Any discipline); MBA in Hospital Administration or Healthcare Management would be an advantage. Minimum 1-3 years of experience in hospital insurance coordination or TPA interaction. Strong knowledge of health insurance policies, procedures, and documentation. Excellent communication, negotiation, and follow-up skills. Proficiency in hospital software, billing systems, and MS Office. Ability to handle pressure and ensure timely approvals/discharges.

Key Competencies

Attention to detail Patient communication & service orientation Coordination & teamwork Problem-solving and timely escalation Knowledge of insurance workflows & coding Professional conduct and confidentiality

Work Schedule

Full-time; rotational shifts may be applicable based on hospital policy.

Additional Notes

The Insurance Co-ordinator plays a crucial role in ensuring the financial and operational smoothness of patient care at Adhventha Hospital, making the position essential for excellent patient experience and efficient hospital functioning.

Job Types: Full-time, Permanent

Pay: ?25,000.00 - ?30,000.00 per month

Work Location: In person