Knowledge of MJPJAY/PMJAY packages and guidelines
Positive knowledge of hospital documentation and medical terminology
Computer and online portal skills
Knowledge of e-preauthorisation and claim processing
Valuable communication and coordination skills
Ability to work with consultants, patients, hospital staff and insurance/TPA teams
Attention to documentation and deadlines
Ability to handle patient grievances professionally
Patient evaluation: Ensure required investigations and diagnostic tests are provided free of cost and reports are uploaded to the MJPJAY portal.
OP/IP status: Assess the patient and update whether the case is OPD or IPD.
Scheme/package verification: Check whether the patient's diagnosis and proposed treatment are covered under an MJPJAY package.
Admission: Facilitate timely admission of eligible patients.
Documentation: Upload admission notes, clinical notes, investigation reports, pre-operative and post-operative records.
Pre-authorisation: Prepare and submit complete e-preauthorisation requests with required documents, photographs and investigation reports.
Coordination: Coordinate with treating consultants, insurer/TPA doctors and MJPJAY authorities regarding pending or rejected pre-authorisations.
Daily clinical updates:
Maintain and upload pre-operative/post-operative clinical notes as required.
Surgery/procedure: Ensure treatment is performed according to the applicable medical protocols and MJPJAY package guidelines.
Photographs: Ensure required pre-operative, post-operative and discharge photographs are captured and uploaded.
Discharge: Update surgery and discharge details and ensure the patient receives the required discharge summary and follow-up advice.
Claims: Check that all required documents are complete and submit claims through the online system; follow up on pending technical/financial queries.
Patient grievances: Attend to MJPJAY beneficiary complaints and coordinate with the concerned authorities for resolution.
Transportation: Ensure eligible transportation reimbursement is provided at discharge.
Follow-up: Facilitate free eligible follow-up consultation, investigations and medicines as per MJPJAY guidelines.
Records/MIS: Maintain accurate online records and provide reports as required by the hospital, insurer and MJPJAY.