- Handle all TPA and insurance panel patients.
- Verify patient eligibility and insurance coverage.
- Process cashless admission formalities.
- Prepare and submit pre-authorisation requests.
- Follow up for approval and enhancement approvals.
- Coordinate with doctors for clinical documents.
- Handle Ayushman Bharat / PM-JAY cases.
- Verify Ayushman beneficiary details and documents.
- Process Ayushman pre-authorisation and claims.
- Handle CGHS patient registration and billing.
- Verify CGHS eligibility and required approvals.
- Handle corporate and institutional panel patients.
- Coordinate with TPA/insurance companies for approvals.
- Coordinate with billing, medical records, pharmacy and clinical departments.
- Arrange final discharge approval from TPA/panel.
- Prepare and submit complete claim documents.
- Follow up on pending claims and payments.
- Handle insurance/TPA queries and objections.
- Track rejected, approved and pending claims.
- Monitor deductions and short settlements.
- Maintain panel-wise records and claim trackers.
- Ensure timely submission of bills and claims.
- Maintain proper documentation and patient records.
- Follow hospital SOPs and panel/insurance guidelines.
- Assist in audits and resolve documentation discrepancies.