. Job Summary

The TPA (PM-JAY) Executive is responsible for managing Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) patient documentation, beneficiary verification, pre-authorisation, claim submission, and coordination with doctors, billing, and medical records departments to ensure smooth cashless treatment for eligible patients.
Key Responsibilities
Verify Ayushman card details, patient identity, and scheme eligibility.
Register eligible patients and process cases through the authorized PM-JAY portal.
Collect and verify the required patient documents and medical records.
Coordinate with treating doctors to obtain clinical notes, investigation reports, and treatment plans.
Submit pre-authorisation requests according to the applicable scheme guidelines.
Monitor approval status and follow up on pending pre-authorisation requests and queries.
Ensure treatment and billing are processed according to the approved package and applicable scheme rules.
Collect discharge summaries, investigation reports, operative notes, and other required claim documents.




Submit claims within the prescribed timelines and monitor claim status.
Follow up on rejected, queried, or pending claims and coordinate corrective action.
Maintain accurate records of patient cases, approvals, claims, and payments.
Coordinate with the billing department, doctors, nursing staff, medical records department, and hospital administration.
Assist during internal and external audits related to PM-JAY cases.
Ensure compliance with PM-JAY guidelines and hospital policies.
Eligibility Criteria
Graduate in any discipline; healthcare administration or hospital management qualifications preferred.
Experience in hospital TPA, Ayushman Bharat, insurance desk, or medical billing preferred.
Knowledge of patient documentation, claim processing, and basic computer applications.
Valuable communication, coordination, and record-management skills.

Pay: ₹10,000.00 - ₹20,000.00 per month

Perks:
Health insurance
Provident Fund

Work Location: In person

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