RESPONSIBILITIES
It is the primary responsibility to ensure timely submission of Pre Auth, Query and obtain an approval from TPA | Insurance in accordance with the defined TAT Ensure that all the above data to be captured into Google Sheet | Assigned Portal
Maintain guest satisfactions. All telephone calls and email must be responded immediately.
Ensure proper counselling of the patient| by stander about KIMSHEALTH Policy on insured guests
Maintain regular communication with TPA authorities at all level
DUTIES
Confirm the patient’s TPA is empaneled with our hospital. Please Refer to the Annexure or obtain confirmation from the Marketing Department if in doubt
Brief normal process of TPA about coverage perks, Co-payment and non medical
Collect all required documents from the Patient as per the below check list
Tracker Entry must be maintained properly for more details please refer to the Policy regarding
Scheme updating in YASASII
Ensure all Pre Auth documents to be vetted by the IMOs. Deviations must be recorded properly




Submission of Pre- Auth to concerned TPA with the required documents
Tracking of Pre-Authorization, if approval intimate to patient or denial it must be intimate to IP Billing and Patients
If the TPA has raised any query and it should be tracked based on the nature of query like clinical and non-clinical. Clinical queries must be handed over to treating doctor as per the defined TAT. Non-Clinical queries must be responded as per the defined TAT

DURING THE TREATMENT
During the treatment, we have to submit the interim bill with justification on every 07 days for obtaining Enhancement approval and ensure the patient’s insurance coverage remain valid and active. If the sum assured exhausted, it should be intimated to the patient and IP billing for collection of difference amount
If the patient has more than one policy or top up and the patient would like to submit the balance amount to other TPA. It should be intimated to Insurance Operation Head im

📌 Executive - RCM KHML (Thiruvananthapuram)
🏢 Quality Care India
📍 Thiruvananthapuram