Corporate Billing-Hospital

Aster DM Healthcare; Raipur; On-site; INR 300,000 - 420,000; Full time

Job summary

Aster DM Healthcare in Raipur, India, seeks a Billing and Claims specialist to manage cashless pre-authorizations, hospital billing, discharge processing, and claims upload. The role focuses on ensuring accurate eligibility checks, proper tariff application, timely discharge bills, and fast claim submissions.

You will coordinate with TPAs and SHA, reconcile bills, and resolve queries to minimize rejections, maintaining KPI targets for discharge time, rejection rates, and submission speed.

Responsibilities

• Verify patient insurance cards, corporate credit letters, or authenticate beneficiaries on the Ayushman BIS portal using Aadhaar/Ration cards.
• Prepare and submit clinical documents on corporate TPA portals and the Ayushman TMS portal to secure early approval.
• Monitor ongoing IPD cases and file for financial extension approvals when treatment costs exceed initial limits.
• Post daily charges for room rent, ICU, OT, pharmacy, and diagnostics into the Hospital Information System (HIS).
• Apply correct tariff codes as per agreed corporate contracts and standard Ayushman package rates.
• Pre-Discharge Audit: Cross-verify final summaries and clinical charts against bills to eliminate under-billing or over-billing errors.
• Calculate and explain non-payable items, deductibles, or co-payments clearly to patients before discharge.
• Process final bills within target turnaround times to maintain smooth hospital bed turnover.
• Compile complete claim files including discharge summaries, original bills, investigation reports, and mandatory pre/post-op photos.
• Upload clean claims on respective insurance and government portals within 24 to 48 hours of discharge.
• Address and resolve technical or medical queries raised by TPA doctors or the State Health Agency (SHA) auditor to prevent rejections.
• Discharge Time: Complete the final billing process within 2 hours of receiving clinical discharge orders.
• Claim Rejections: Keep the final claim rejection and deduction rate below 3%.
• Submission Speed: Ensure 100% of claims are digitally submitted within 48 hours of patient exit.

Job description

Key Responsibilities1. Cashless Pre-Authorization & Verification

• Eligibility Check: Verify patient insurance cards, corporate credit letters, or authenticate beneficiaries on the Ayushman BIS portal using Aadhaar/Ration cards.
• Initial Approvals: Prepare and submit clinical documents on corporate TPA portals and the Ayushman TMS portal to secure early approval.
• Enhancements: Monitor ongoing IPD cases and file for financial extension approvals when treatment costs exceed initial limits.

2. Hospital Billing & Tariff Compliance

• Service Posting: Post daily charges for room rent, ICU, OT, pharmacy, and diagnostics into the Hospital Information System (HIS).
• Rate Application: Apply correct tariff codes as per agreed corporate contracts and standard Ayushman package rates.
• Pre-Discharge Audit: Cross-verify final summaries and clinical charts against bills to eliminate under-billing or over-billing errors.

3. Discharge Processing & Counseling

• Co-Pay Management: Calculate and explain non-payable items, deductibles, or co-payments clearly to patients before discharge.
• Smooth Clearance: Process final bills within target turnaround times to maintain smooth hospital bed turnover.

4. Claims Upload & Query Resolution

• File Assembly: Compile complete claim files including discharge summaries, original bills, investigation reports, and mandatory pre/post-op photos.
• Portal Submission: Upload clean claims on respective insurance and government portals within 24 to 48 hours of discharge.
• Query Settlement: Address and resolve technical or medical queries raised by TPA doctors or the State Health Agency (SHA) auditor to prevent rejections.

Key Performance Indicators (KPIs)

• Discharge Time: Complete the final billing process within 2 hours of receiving clinical discharge orders.
• Claim Rejections: Keep the final claim rejection and deduction rate below 3%.
• Submission Speed: Ensure 100% of claims are digitally submitted within 48 hours of patient exit.