- Verify patient eligibility under ECHS and CGHS schemes.
- Check referral letters, authorization letters, entitlement cards, and identity documents.
- Ensure all mandatory documents are collected before admission and discharge.
- Maintain complete patient files as per ECHS/CGHS guidelines.
Billing & Claim Preparation
- Prepare accurate inpatient and outpatient bills.
- Ensure billing is as per approved package rates and government guidelines.
- Verify charges before claim submission.
- Prepare final claim files with all supporting documents.
Claim Submission
- Submit ECHS and CGHS claims within prescribed timelines.
- Upload claims on designated portals wherever applicable.
- Maintain claim submission records and acknowledgement copies.
- Track submitted claims until settlement.
Coordination
- Coordinate with:
- Doctors
- Nursing Department
- Medical Records Department (MRD)
- Pharmacy
- Diagnostic Services
- Finance Department
- ECHS Polyclinics
- CGHS Wellness Centres
- Resolve documentation deficiencies before claim submission.
Payment Follow-up
- Follow up for pending claims and payments.
- Respond to deficiency letters and queries raised by ECHS/CGHS authorities.
- Coordinate for re-submission of deficient claims.
- Maintain ageing reports of outstanding claims.
MIS & Reporting
- Prepare daily, weekly, and monthly reports on:
- Admissions
- Claims submitted
- Claims pending
- Deficiencies
- Payments received
- Outstanding receivables
- Share reports with management.
Compliance
- Ensure compliance with ECHS and CGHS billing policies.
- Stay updated with revised package rates and government notifications.
- Maintain confidentiality of patient and financial records.
Record Management
- Maintain physical and digital records of all claims.
- Ensure documents are readily available during audits.
- Assist during internal and external audits.