Ayushman Billing Executive

Shri Khatu Shyam Healthcare; India; On-site; INR 600,000 - 900,000; Full time

Job summary

Shri Khatu Shyam Healthcare is seeking a dedicated professional to manage end-to-end PMJAY/Ayushman Bharat portal operations and claims processing. You will verify eligibility, review medical records, and ensure documents are complete before submission to guarantee accurate claims.

You will coordinate with doctors, nursing staff, billing, TPA, and medical records teams to complete claims within timelines, track authorizations, deficiencies, and settlements, and ensure strict compliance with

Qualifications

• Graduate in any discipline; healthcare/hospital administration preferred.
• 26 years of relevant PMJAY/government health scheme claims experience.
• Experience in a hospital setting preferred.

Responsibilities

• Manage end-to-end PMJAY/Ayushman Bharat portal operations.
• Verify patient eligibility and package selection per scheme guidelines.
• Review medical records and ensure documents are complete before submission.
• Validate treatment package matches diagnosis and supporting documents.
• Coordinate with doctors, nursing, billing, TPA, and medical records teams for claim completion.
• Submit pre-authorizations, discharge requests, and final claims within timelines.
• Track pending authorizations, queries, deficiencies, and settlements.
• Resolve portal queries and coordinate for claim resubmissions as needed.
• Ensure compliance with PMJAY, state schemes, and hospital SOPs.
• Maintain records and generate MIS reports related to claims and portal performance.
• Guide portal operations team to ensure smooth workflow.

Skills

PMJAY

Claims management

Portal operations

Coordination

Education

Graduation

Job description

Role & responsibilities

• Manage end-to-end PMJAY/Ayushman Bharat portal operations.
• Verify patient eligibility and package selection as per scheme guidelines.
• Review medical records and ensure all required documents are complete before claim submission.
• Validate that the selected treatment package matches the diagnosis, procedure, and supporting clinical documents.
• Coordinate with doctors, nursing staff, billing, TPA, and medical records teams for claim completion.
• Submit pre-authorizations, discharge requests, and final claims within prescribed timelines.
• Track pending authorizations, queries, deficiencies, and claim settlements.
• Resolve portal queries and coordinate for claim resubmissions whenever required.
• Ensure compliance with PMJAY, state health schemes, and hospital SOPs.
• Maintain accurate records and generate MIS reports related to claims and portal performance.
• Guide and monitor the portal operations team to ensure smooth workflow.

Preferred candidate profile

• Previously handled complete PMJAY claim operations independently.
• Familiar with package approvals, claim settlements, audits, and deficiency management.
• Strong attention to detail with the ability to ensure high claim acceptance rates.

Eligibility

• Graduate in any discipline (Healthcare/Hospital Administration preferred).
• 26 years of relevant experience in PMJAY or government health scheme claim management.
• Experience working in a hospital is preferred.