Billing Executive(RGHS/TPA/ Maa Yojna)

Bhagwan Mahaveer Cancer Hospital & Research Centre; Jaipur; Sur place; INR 400 000 - 600 000; Plein temps

Résumé du poste

Bhagwan Mahaveer Cancer Hospital & Research Centre in Jaipur is seeking an experienced administrator to manage RGHS, Bhamashah and TPA processes, ensuring smooth registration, eligibility checks, pre-authorization and final claim submission.

The role coordinates with patients, departments and TPAs, maintains documentation, generates MIS reports and ensures timely settlements while protecting patient confidentiality and complying with guidelines.

Qualifications

• Good knowledge of RGHS, Bhamashah and TPA processes.
• Knowledge of cashless hospitalization and insurance claim procedures.
• Understanding of pre-authorization, enhancement and final claim submission.
• Knowledge of medical documentation and hospital billing procedures.
• Proficiency in MS Excel, MS Office and hospital information systems (HIS).
• Strong communication, coordination and follow-up skills.
• Ability to handle multiple cases and meet claim submission deadlines.
• Attention to detail and problem-solving abilities.

Responsabilités

• Handle RGHS and Bhamashah patient registration, eligibility verification and beneficiary identification.
• Verify patient eligibility, scheme validity, entitlement and available benefits.
• Coordinate with patients, attendants and concerned departments regarding scheme-related formalities.
• Ensure proper documentation and compliance with applicable scheme guidelines.
• Coordinate with government authorities and scheme representatives for approvals and clarifications.
• Handle cashless patient admission and insurance-related formalities.
• Coordinate with various TPAs and insurance companies for pre-authorization approvals.
• Prepare and submit pre-authorization requests along with relevant medical documents.
• Follow up on pending approvals, enhancement requests and queries raised by TPAs.
• Coordinate with doctors and clinical departments for medical justifications and supporting documents.
• Ensure timely submission of final claims and discharge summaries.
• Prepare, verify and process RGHS, Bhamashah and TPA claims.
• Ensure accuracy and completeness of claim documents before submission.
• Monitor claim status and follow up on pending, rejected and query-raised claims.
• Coordinate for claim deficiencies, deductions and re-submission wherever required.
• Maintain records of claim submissions, approvals, rejections and settlements.
• Identify reasons for claim deductions and take corrective action.
• Coordinate with Billing, Medical Records Department (MRD), Medical Administration, Pharmacy and other clinical departments.
• Maintain daily reports of admissions, approvals, pending cases and claim submissions.
• Prepare monthly MIS reports covering claim status, outstanding amounts, rejections and deductions.
• Ensure timely resolution of patient and departmental queries.
• Maintain proper records and ensure confidentiality of patient information.

Connaissances

RGHS & Bhamashah processes

Insurance claim procedures

Pre-authorization knowledge

Documentation & billing

MS Excel

Interpersonal communication

Deadline-driven

Hospital coordination

Outils

MS Excel

Hospital Information System (HIS)

Description du poste

Key Roles & Responsibilities:-

A. RGHS & Bhamashah Operations

1. Handle RGHS and Bhamashah patient registration, eligibility verification and beneficiary identification.
2. Verify patient eligibility, scheme validity, entitlement and available benefits.
3. Coordinate with patients, attendants and concerned departments regarding scheme-related formalities.
4. Ensure proper documentation and compliance with applicable scheme guidelines.
5. Coordinate with government authorities and scheme representatives for approvals and clarifications.

B. TPA & Insurance Operations

1. Handle cashless patient admission and insurance-related formalities.
2. Coordinate with various TPAs and insurance companies for pre-authorization approvals.
3. Prepare and submit pre-authorization requests along with relevant medical documents.
4. Follow up on pending approvals, enhancement requests and queries raised by TPAs.
5. Coordinate with doctors and clinical departments for medical justifications and supporting documents.
6. Ensure timely submission of final claims and discharge summaries.

C. Claims Processing & Settlement

1. Prepare, verify and process RGHS, Bhamashah and TPA claims.
2. Ensure accuracy and completeness of claim documents before submission.
3. Monitor claim status and follow up on pending, rejected and query-raised claims.
4. Coordinate for claim deficiencies, deductions and re-submission wherever required.
5. Maintain records of claim submissions, approvals, rejections and settlements.
6. Identify reasons for claim deductions and rejections and take corrective action.

D. Coordination & Reporting

1. Coordinate with Billing, Medical Records Department (MRD), Medical Administration, Pharmacy and other clinical departments.
2. Maintain daily reports of admissions, approvals, pending cases and claim submissions.
3. Prepare monthly MIS reports covering claim status, outstanding amounts, rejections and deductions.
4. Ensure timely resolution of patient and departmental queries.
5. Maintain proper records and ensure confidentiality of patient information.

Required Knowledge & Skills:-

• Good knowledge of RGHS, Bhamashah and TPA processes.
• Knowledge of cashless hospitalization and insurance claim procedures.
• Understanding of pre-authorization, enhancement and final claim submission.
• Knowledge of medical documentation and hospital billing procedures.
• Proficiency in MS Excel, MS Office and hospital information systems (HIS).
• Strong communication, coordination and follow-up skills.
• Ability to handle multiple cases and meet claim submission deadlines.
• Attention to detail and problem-solving abilities.