Role & responsibilities

- Manage end-to-end PMJAY/Ayushman Bharat portal operations.
- Verify patient eligibility and package selection as per scheme guidelines.
- Review medical records and ensure all required documents are complete before claim submission.
- Validate that the selected treatment package matches the diagnosis, procedure, and supporting clinical documents.
- Coordinate with doctors, nursing staff, billing, TPA, and medical records teams for claim completion.
- Submit pre-authorizations, discharge requests, and final claims within prescribed timelines.
- Track pending authorizations, queries, deficiencies, and claim settlements.
- Resolve portal queries and coordinate for claim resubmissions whenever required.
- Ensure compliance with PMJAY, state health schemes, and hospital SOPs.




- Maintain accurate records and generate MIS reports related to claims and portal performance.
- Guide and monitor the portal operations team to ensure smooth workflow.

Preferred candidate profile

- Previously handled complete PMJAY claim operations independently.
- Familiar with package approvals, claim settlements, audits, and deficiency management.
- Robust attention to detail with the ability to ensure high claim acceptance rates.

Eligibility

- Graduate in any discipline (Healthcare/Hospital Administration preferred).
- 26 years of relevant experience in PMJAY or government health scheme claim management.
- Experience working in a hospital is preferred.

📌 Ayushman Billing Executive (New Delhi)
🏢 Shri Khatu Shyam Healthcare
📍 New Delhi