Insurance Co-ordinator

Job Description: Insurance Co-ordinatorPosition Title: Insurance Co-ordinatorDepartment: Insurance & Billing / OperationsReports To: Operations Manager / Hospital AdministratorEmployment Type: Full-TimePosition Summary

The Insurance Co-ordinator will be responsible for managing all insurance-related processes for patients, including pre-authorizations, approvals, documentation, billing coordination, and discharge clearances. The role ensures seamless communication between the hospital, patients, and insurance companies, while maintaining accuracy, compliance, and excellent patient service.

Key Responsibilities1. Pre-Authorization & Approvals

• Verify patient insurance coverage and eligibility at the time of admission or prior to procedures.
• Submit required clinical documents to insurance TPAs/companies for obtaining pre-authorization.
• Follow up proactively for approvals and update the concerned departments and patients.
• Ensure accuracy in coding, diagnosis, procedures, and other clinical details submitted for approval.

2. Documentation & Compliance

• Maintain updated knowledge of insurance policies, TPA requirements, approval limits, and documentation standards.
• Ensure all necessary forms (pre-auth, claim forms, undertaking, etc.) are completed and signed appropriately.
• Coordinate with doctors and nursing teams to collect clinical notes, discharge summaries, and operative details needed for claims.
• Adhere strictly to NABH, hospital, and insurance compliance standards.

3. Billing & Claims Processing

• Coordinate with the billing department to prepare estimated bills for insurance patients.
• Reconcile approvals with final billing to avoid discrepancies.
• Ensure timely submission of final claim documents and bills to the insurance providers.
• Resolve queries raised by TPAs/insurance companies and ensure smooth claim settlement.

4. Patient Coordination & Communication

• Communicate insurance coverage, approval status, exclusions, and out-of-pocket expenses clearly to patients and families.
• Address patient concerns politely and professionally, ensuring transparency and comfort throughout their hospital journey.
• Assist patients with insurance forms and explain necessary documentation.

5. Discharge Coordination

• Ensure final bill approvals and clearances are obtained on time to avoid discharge delays.
• Coordinate with the medical, nursing, and billing teams to ensure proper discharge workflow.
• Manage last-minute insurance queries efficiently for smooth patient exit.

6. Operational & Administrative Support

• Maintain accurate records and logs for all insurance patients.
• Prepare daily/weekly MIS reports on admissions, approvals, and pending claims.
• Build and maintain relationships with TPA representatives and insurance desk personnel.
• Assist in internal audits, quality checks, and departmental meetings.

Qualifications & Requirements

• Graduate (Any discipline); MBA in Hospital Administration or Healthcare Management would be an advantage.
• Minimum 1–3 years of experience in hospital insurance coordination or TPA interaction.
• Strong knowledge of health insurance policies, procedures, and documentation.
• Excellent communication, negotiation, and follow-up skills.
• Proficiency in hospital software, billing systems, and MS Office.
• Ability to handle pressure and ensure timely approvals/discharges.

Key Competencies

• Attention to detail
• Patient communication & service orientation
• Coordination & teamwork
• Problem-solving and timely escalation
• Knowledge of insurance workflows & coding
• Professional conduct and confidentiality

Work Schedule

• Full-time; rotational shifts may be applicable based on hospital policy.

Additional Notes

The Insurance Co-ordinator plays a crucial role in ensuring the financial and operational smoothness of patient care at Adhventha Hospital, making the position essential for excellent patient experience and efficient hospital functioning.

Job Types: Full-time, Permanent

Pay: ₹25,000.00 - ₹30,000.00 per month

Work Location: In person