COORDINATOR – MEDICLAIM

KEM Hospital Pune; Pune District; On-site; INR 260,000 - 380,000; Full time

Job summary

KEM Hospital Pune seeks a candidate for patient financial services focusing on mediclaim counselling and admission procedures. Responsibilities include documenting medical details, processing preauthorizations, and coordinating discharge planning with clinical staff.

The role involves interactions with consultants, TPAs, and clerical teams to streamline patient care and financial paperwork.

Qualifications

• BSc Nursing / M.Sc Nursing / PGDHM or equivalent.
• BAMS / BHMS.
• EMS would be an added advantage.
• 0 – 1 years experience; TPA experience preferred.

Responsibilities

• Counselling the patient and/or relatives regarding mediclaim procedures.
• Counselling the patient regarding admission procedure and deposit requirements, especially for operative procedures and when sum limit is exhausted.
• Providing medical details to the clerical section.
• Preauthorization forms for admitted patients and pre-approvals.
• Query replies when documents are required from the patient or justification from the treating doctor.
• Monitoring the medical progress including changes in treatment plan, cost, or length of stay (paperwork).
• Assisting with medical details/changes for documentation with resident doctors.
• Interacting with consultants as required.
• Coordinating discharge of the patient.
• Counselling on discharge procedure, time required, approximate payment.
• Filling reimbursement forms for non-cashless patients and replying to TPAs.
• Conducting regular ward rounds.
• Any other work assigned by HOD/Management.

Skills

Counselling

TPA experience

Education

BSc Nursing / M.Sc Nursing / PGDHM

BAMS / BHMS

EMS would be an added advantage

Job description

QUALIFICATION:

• BSc Nursing / M.Sc Nursing / PGDHM
• BAMS / BHMS
• EMS would be an added advantage

EXPERIENCE:

• 0 – 1 years
• TPA experience preferred

JOB RESPONSIBILITIES:

• Counselling of the patient and/or relatives regarding mediclaim procedures
• Counselling the patient regarding admission procedure, counselling about deposit specially in case of operative procedures. Deposit in case of sum limit exhausted.
• Providing medical details to the clerical section
• Preauthorization form of admitted patient and pre-approvals
• Query replies – if any documents is required from the patient, or any justification from treating doctor
• Monitoring the medical progress of the patient like change in the treatment plan, treatment cost or change in the anticipated length of stay (paperwork)
• Providing with the help of resident doctors, medical details and justifications for any changes for documentation purposes
• Interacting with the consultants, whenever required
• Coordinating discharge of the patient
• Counselling of the patient regarding the discharge procedure, time required, amount to be paid in approximate amount
• Filling the reimbursement form of non-cashless patient and replying to any query raised from TPA
• Conducting regular ward rounds.
• Any other work/responsibility assigned by the HOD/Management in the course of business/work whether within the same unit/dept or any other unit/dept from time to time