Welcare Hospital, Vadodara, is looking for a responsible and experienced TPA Billing Executive to join our hospital billing team. The candidate should have practical knowledge of TPA billing, insurance claims processing, and PMJAY (Ayushman Bharat) portal operations.
Key Responsibilities
- Handle TPA and insurance billing processes for IPD and OPD patients.
- Manage patient insurance documentation and claim-related formalities.
- Process pre-authorization requests and coordinate with TPA/insurance companies.
- Prepare and submit accurate medical bills and insurance claim documents.
- Follow up on claim approvals, queries, deductions, and settlements.
- Coordinate with doctors, nursing, billing, and medical records departments.
- Ensure timely submission of complete patient documents for claim processing.
- Maintain proper records of TPA and insurance billing transactions.
- Resolve billing discrepancies and coordinate with concerned departments.PMJAY / Ayushman Bharat Responsibilities
- Practical knowledge of the PMJAY (Ayushman Bharat) portal is required.
- Handle Ayushman Bharat patient registration and eligibility verification.
- Process pre-authorization requests through the PMJAY portal.
- Upload and manage required patient documents and medical records.
- Coordinate with the concerned departments for package selection and approval.
- Manage discharge formalities and claim submission on the Ayushman portal.
- Follow up on claim status, queries, rejections, and pending approvals.
- Maintain accurate records of PMJAY beneficiaries and claim-related documents.Requirements & Qualifications
- Bachelor's degree in any relevant field (preferred).
- 0–1 years of experience in TPA billing, hospital billing, or insurance claims.
- Knowledge of PMJAY / Ayushman Bharat portal is mandatory or preferred, based on hospital requirements.
- Knowledge of insurance and TPA claim procedures.
- Good communication and coordination skills.
- Basic computer knowledge and hospital management system experience.
- Ability to work accurately under pressure in a hospital environment.
- Knowledge of Hindi, Gujarati, and English is preferred.