JOB DESCRIPTION – AYUSHMAN EXECUTIVE

Department: Ayushman / TPA
Designation: Ayushman Executive
Location: Guardian Hospital, Ambala
Reporting To: Hospital Administrator / TPA Manager
Accountable To: Medical Superintendent / Hospital Administration

Job Purpose

To manage and coordinate all Ayushman Bharat (PM-JAY) related activities, including patient eligibility, pre-authorisation, documentation, package processing, claim submission, query resolution and coordination with the concerned authorities to ensure smooth processing of Ayushman cases.

Key Responsibilities

- Verify patient Ayushman card, eligibility and beneficiary details at the time of admission.
- Coordinate the Ayushman admission and registration process with the concerned departments.
- Prepare and submit pre-authorisation requests for planned and emergency cases.
- Ensure that all required patient documents, clinical records and investigations are properly maintained and uploaded.
- Coordinate with doctors, nursing staff, MRD, billing and other departments for complete Ayushman documentation.
- Monitor pre-authorisation status, approval, queries and package-related issues.
- Prepare and submit claim packages within the prescribed timelines.
- Follow up on submitted claims and coordinate for query resolution, deficiencies and claim objections.
- Maintain proper records of Ayushman admissions, approvals, discharges, claims and pending cases.
- Check that discharge summaries, operative notes, investigation reports and other required documents are complete before claim submission.
- Coordinate with the Ayushman portal and concerned officials for case-related issues.
- Track claim status, deductions, rejections and pending payments and report the same to the reporting authority.




- Ensure proper documentation and compliance with applicable Ayushman guidelines and hospital procedures.
- Maintain confidentiality of patient and hospital information.
- Prepare daily/weekly/monthly reports related to Ayushman cases as required by management.

Job Specifications

Educational Qualification: Graduate in any stream; healthcare/medical administration background preferred.

Experience: 1–3 years of experience in Ayushman, TPA, hospital billing, insurance or healthcare administration preferred.

Skills Required:

- Knowledge of Ayushman/PM-JAY processes
- Hospital documentation and billing knowledge
- Computer and portal handling skills
- Valuable communication and coordination skills
- Documentation and record-management skills
- Ability to follow up on pending cases and queries
- Attention to detail

Reporting Relationship

Reports To: Hospital Administrator / TPA Manager

Functional Coordination With: Doctors, Nursing Department, MRD, Billing Department, Accounts, Reception, Pharmacy, Diagnostics and Hospital Administration.

Accountability

The Ayushman Executive shall be accountable for:

- Timely processing of Ayushman cases
- Accuracy and completeness of documentation
- Timely pre-authorisation and claim submission
- Proper follow-up of queries and objections
- Maintaining accurate Ayushman records
- Timely reporting of pending and rejected cases
- Compliance with hospital procedures and applicable Ayushman requirements

Performance Indicators

- Timely pre-authorisation processing
- Complete and accurate documentation
- Timely claim submission
- Reduction in avoidable claim queries/rejections
- Timely resolution of deficiencies
- Proper maintenance of Ayushman records
- Coordination and follow-up with concerned departments

Pay: From ₹14,000.00 per month

Benefits:

- Cell phone reimbursement
- Paid sick time
- Paid time off

Work Location: In person

📌 Ayushman execuitve (India)
🏢 GUARDIAN HOSPITAL AMBALA CANTT
📍 India