ROLE DETAILS To be filled up as per the requirement of the Division / unit / function / territory
Grade
A3
Reporting To
Mediclaim Manager
Division
Unit
Unit
Indore
LOCATION DETAILS
Please mention the correct office location of the Role selected above and fill in the other geographic details
Base Location (City)
Indore
Country
India
Job-Holder Specifications
QUALIFICATION
Basic Qualification / Education / Vocational Training
Graduation in any discipline
Advanced
Qualification / Certification / Specialist Training
NA
EXPERIENCE
Minimum Experience
2 years
Specific / Relevant Experience
2 years
COMPETENCIES
Functional Skills and Capabilities
Behavioural
- Courteous and qualified approach
- Responsible in nature
- Polite in speech
- Problem solving ability
- Tolerant
Functional
- Knowledge about mediclaim procedure for TPA
- Well equipped with computers
- Thorough with company knowledge and packages
- Documentation of data
Objective To carry out the administrative and billing procedure by providing accurate estimates, checking the outstanding and smooth discharge process for TPA clients in the Mediclaim department.
Key Responsibilities
1
TPA Procedures
- Receiving discharge file from mediclaim
- Preparation of checklist as per requirement
- Handling and preparation of TPA files
- Receiving approval as per patient for outstanding for TPA
- Making online approvals for approval of estimates and entering reference number, ID number, name
- Reviewing of payments online from time to time
- Making settlement entries after receiving from accounts department
- Identifying TPA portals and mails for making and tallying settlements.
- Making entry in portal, tally and careworks
- Analysing the payment received into legitimate and illegitimate
- Provide reasoning and communication for illegitimate payments
- Updating the payments on the CEO tracer
- Preparation of outstanding report patient wise on a monthly basis
- After the discharge, follow up with companies for outstanding payments
- Maintaining database about international patient for outstanding payment of assigned units.
- Resolving queries related to file submission and payments
- Coordinating within the department as per requirement
- Visiting the TPA agencies whenever required for early recovery of the dues.
- Follow up with departments for missing documents
- Completion of patient files as per requirements of Insurance companies.
- For CGHS and ECHS cases, claim processing to be done within 1 week or as stipulated.
- Visiting the coordinators of CGHS and ECHS whenever required to resolve queries.
Employee Name
Ms. Tapur Joshi
Employee Signature
Received on (Date)
Version No: 001/ 2018-19
📌 Billing-Executive (Indore)
🏢 SHALBY
📍 Indore
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