Job Description

The Insurance Coordinator is responsible for managing all activities related to patient insurance processing within the hospital. This includes handling pre-authorizations, insurance claims submission, approvals, follow-ups with TPAs/insurance companies, and ensuring timely reimbursements. The role is key to revenue cycle efficiency and patient satisfaction.

Key Responsibilities:

Pre-Authorization & Approvals

Obtain pre-authorizations from insurance companies/TPAs for surgeries, procedures, and admissions. Ensure all necessary documentation (consultation notes, investigation reports, etc.) is attached with pre-auth requests. Coordinate with medical and nursing staff to facilitate timely documentation.

Claims Processing

Prepare and submit insurance claims (cashless and reimbursement) in a timely and accurate manner. Scrutinize medical bills and discharge summaries for completeness and correctness before submission. Track claims status regularly and follow up with insurance/TPA teams for pending approvals.

Billing Coordination

Coordinate with billing and finance teams to ensure accurate mapping of insurance policies and packages. Verify policy validity, coverage limits, exclusions, and co-payments. Guide patients/families regarding their insurance eligibility and coverage.

TPA & Insurance Communication

Serve as the primary point of contact between the hospital and insurance/TPA representatives. Maintain cordial and professional relationships with all external parties. Resolve claim denials or discrepancies through negotiation and documentation support.

Documentation & Compliance

Ensure proper documentation of all communications, approvals, and claim-related records. Maintain patient insurance files and databases with confidentiality. Stay updated with changes in insurance guidelines, IRDA norms, and hospital policy.

Reporting

Generate periodic reports on claim status, TAT, pending amounts, rejected claims, and collection trends. Escalate delays and bottlenecks to management as necessary

Working Conditions

:

Full-time, based in the hospital premises May involve shift duties (depending on hospital operations) Interaction with patients, doctors, and third-party representatives Teamwork and interdepartmental coordination Ethical and transparent work practices Problem-solving and analytical thinking
Job Types: Full-time, Permanent, Fresher

Pay: From ?15,000.00 per month

Work Location: In person