Executive - PMJAY / Ayushman Bharat Operations

Position Overview

Job Title

Executive - PMJAY / Ayushman Bharat Operations

Department

Billing & Government Health Schemes (TPA / PMJAY Desk)

Experience Required

0 to 2 Years (Freshers Or Hospital Administration/Life Sciences background welcome)

Take-Home Salary

Up to ₹25,000 per month (in-hand, commensurate with experience)

Employment Type

Full-time, In office

Role Purpose

The PMJAY Executive manages the end-to-end processing of beneficiaries under the Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and associated state government health schemes. The role ensures prompt eligibility verification, pre-authorization submissions, query resolution, and timely claim settlements while upholding hospital service standards.

Key Responsibilities
- Beneficiary Verification: Verify patient credentials and eligibility on the National Health Authority (NHA) / BIS portal using Golden Cards, Aadhaar, Ration Cards, or PMJAY letters at admission.
- Pre-Authorization Workflow: Coordinate with duty medical officers, nursing staff,



and billing to compile diagnostic reports, clinical summaries, and treatment plans for timely pre-auth submission on the TMS portal.
- Case Paper & File Management: Maintain and assemble comprehensive indoor case papers, OT notes, implant stickers, investigation charts, and pharmacy records in accordance with SHA/ISA guidelines.
- Query Tracking & Resolution: Proactively monitor portal status, address medical/administrative queries raised by State Health Agencies (SHA) or Implementation Support Agencies (ISA), and prevent claim delays.
- Discharge & Claim Settlement: Facilitate discharge documentation, complete biometric verification where mandated, and submit final claim packages within prescribed turnaround times (TAT).
- Patient & Attendant Counseling: Guide beneficiaries through package inclusions, exclusions, and documentation prerequisites clearly and empathetically.
- Education: Bachelor’s Degree i

📌 Executive - Pmjay / Ayushman Bharat Operations (Rajkot)
🏢 Nucleonhealth
📍 Rajkot