Submitting and following up of claims settlement and maintaining claims MIS with settlement details
Operations
Managing front office staff for Govt. credit business- ESI/ECHS /Govt. Schemes and facilitating for the cashless provisions to patients as per eligibility and norms.
Assemble and maintain patient records, review transcriptions and interact with Physicians to ensure all relevant patient information are recorded for submission to authorities.
Coordinating cashless request/medical query/Arbitration with medical teams- both internal and external
Ensuring for approvals on credit facility for scheme patients and settlement after final approval/claim payment receipts.
Maintaining MIS of credit patients including admissions/cashless/submissions/payment settlement status
Ensure timely preparation of claim document and submission with respective authorities.
Managing the timely revert on medical/nonmedical /financial queries on submitted cashless claims
Coordinating for the surgery/OT clearance based on initial approvals or advance /deposits.
Obtaining patient feedback from credit patients & tie up departments
KEY EXTERNAL INTERACTION WITH
NATURE OF INTERACTION
Patients/ Insurance Co./TPAS/ESI/ECHS /Medical Team
Answering Patient Billing queries, work with patients and government authorities to get claim processed and paid.
Liaisoning with Insurance authorities for claim payments/queries/rejection/arbitrations
Objective
This role incumbent is responsible is to work closely with the Insurance /ESI/ECHS/Beneficiaries to ensure timely processing of cashless admissions and submission/settlement of Cashless claims
Key Responsibilities
1 Preparation & Processing of Health Insurance/ Cashless Claims
Submitting and following up of claims, creating and Managing cashless Patient files including admission requests/extended stay approvals/Additional approvals etc.