Candidates with experience in hospital field preferred
- Coordinate with insurance companies, TPAs and corporate insurance departments for patient admissions, treatment approvals and claim processing.
- Verify the patient's insurance/TPA eligibility, coverage, policy limits and exclusions.
- Ensure that all required insurance documents are collected and verified at the time of admission.
- Prepare and submit pre-authorization requests with complete medical and financial documents.
- Coordinate with doctors and clinical departments to obtain necessary medical information for approval.
- Follow up with the insurance company/TPA for approval status and communicate the decision to the concerned departments and patient.
- Ensure that additional approvals are obtained whenever there is a change in treatment, procedure or estimated cost.
- Explain the insurance process, coverage limitations, room eligibility, co-payment and non-payable items to patients/attendants.
- Monitor the patient's insurance eligibility throughout the admission.
- Coordinate with billing, nursing, doctors, pharmacy, laboratory and other departments to ensure proper documentation.
- Prepare and submit the final bill and discharge documents to the insurance company/TPA.
- Obtain final discharge authorization/approval wherever required.
- Ensure that the approved amount and patient-payable amount are clearly communicated to the patient.
- Coordinate with billing for settlement of deductibles, exclusions, co-payments and non-payable amounts.
- Submit claims with all required supporting documents within the prescribed TAT.
- Track pending claims and follow up regularly with insurance companies/TPAs.
- Respond to queries raised by insurance companies/TPAs and provide additional documents promptly.