Job Description

Insurance Coordination & Verification

Verify patient insurance eligibility, coverage, and policy terms before admission or procedures. Ensure accurate documentation from patients for insurance processing. Coordinate with consultants and departments to prepare required documents for authorization.

2. Pre-Authorization & Approvals

Initiate and obtain pre-authorization from insurance companies/TPAs for planned and emergency procedures. Track and maintain records of all approvals, queries, and status updates. Follow up promptly on pending or delayed authorizations.

3. Claims Processing & Submission

Prepare and submit insurance claims with complete and accurate documentation. Review bills, case sheets, discharge summaries, and investigation reports for correctness. Ensure claims are submitted within the stipulated time frame.

4. TPA / Insurance Company Coordination

Liaise with TPA representatives and insurance officers for approvals, queries, and claim clarifications. Maintain professional relationships to ensure seamless coordination. Attend audits and provide required case documents promptly.

5. Discharge & Billing Support

Coordinate with billing and medical records teams to ensure proper coding and documentation. Provide insurance estimates to patients and update them regarding insurance deductions, exclusions, and coverage. Assist in final bill settlement for insured patients.

6. Claim Follow-up & Reconciliation

Track claim status, resubmissions, and payment follow-ups. Handle claim rejections/denials, rectify discrepancies, and coordinate for reprocessing. Prepare monthly reconciliation reports on claims submitted, approved, rejected, and pending.

7. Compliance & Documentation

Ensure all insurance processes comply with hospital policies, IRDAI norms, and TPA guidelines. Maintain secure and organized documentation for audits and verification purposes. Update management on changes in insurance policies, tariffs, and TPA requirements.
Job Type: Full-time

Pay: ₹20,000.00 - ₹30,000.00 per month

Benefits:

Health insurance Leave encashment Paid sick time Provident Fund
Education:

Bachelor's (Preferred)
Experience:

Insurance department (Hospital): 5 years (Preferred)
Language:

Tamil. English (Preferred)
Work Location: In person