Duties and Responsibilities:

1.Pre-Authorization & Insurance Information Services

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Prepare and process insurance forms to initiate patient claims and collect carrier liability.

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Handle pre-authorization and pre-certification for surgeries, treatments, and procedures.

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Provide information on billing procedures, Mediclaim, Health Insurance, and Commercial Insurance.

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Maintain patient insurance files and prepare routine statistical reports.

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Take necessary patient information from consultants, fellows, and residents for documentation.

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Coordinate with internal departments (Front Desk, Surgical Coordination, Speciality Clinics) for company patient appointments, surgeries, and treatments.

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Respond to insurance inquiries, notify patients of liability status, and manage claims correspondence.

2. Billing, Documentation & Claim Processing Services

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Compose, review, and process memos, correspondence, forms, and attachments for completeness and accuracy.

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Evaluate documentation, coding, and billing formats according to client and third-party reimbursement requirements.

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Perform quality control on pre-billed reports and documents; follow up with consultants or residents for missing documentation.

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Submit electronic claims and handle billing for patients, insurance, and clients.

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Generate electronic and paper claims; correct and resubmit rejected claims.

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Work with third-party billing agencies to resolve claim rejections related to medical necessity or pre-certification issues.

3. Accounts, Bookkeeping & Credit Services

Manage accounts receivable, collections, and patient credit in compliance with credit policies.

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Serve as a backup for the Accounts Department’s credentialing coordinator.

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Coordinate credit patient billing, collections, third-party claims, and bookkeeping operations.

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Prepare financial reports, analyses, and recommendations for management.

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Provide account information to authorized personnel and respond to credit/collection inquiries.

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Coordinate with Manager-Accounts for refunds or excess payments to patients.

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Maintain spreadsheets, databases, and filing systems for billing and payment data.

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Post charges and payments using client tariff in HIS.

4. Problem Resolution

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Identify potential credit and billing issues; resolve problems with patients, third-party payers, and government clients.

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Investigate non-routine billing issues and implement remedial actions.

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Escalate unresolved issues to General Manager – BD & Administration.

Pay: ₹25,000.00 - ₹35,000.00 per month

Advantages:

- Paid time off
- Provident Fund

Work Location: In person

📌 Insurance Processor (India)
🏢 Nethradhama Super Speciality Eye Hospital
📍 India