- Clinical Scrutiny: Analyze and approve/deny patient claims by verifying the diagnosis, treatment details, and medical necessity based on insurance policy terms.
- Billing & Coding: Interpret ICD coding, evaluate co-pay/deductibles, and manage the distinction between package and open billing.
- Authorization: Review and process pre-authorizations for cashless treatments.
- Documentation: Ensure all required documentation (discharge summaries, investigations) is complete to avoid claim rejection.
- Liaison: Coordinate with hospital departments (doctors, billing) and TPAs/insurance companies to resolve queries and reduce Turnaround Time (TAT). Docthub +5