Key ResponsibilitiesPatient Registration & Documentation
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.