Pre Authorization - Hospital Claims

Job Summary:

The Pre-Authorization Executive is responsible for handling insurance-related processes for patients admitted under health insurance coverage. The role involves coordinating with doctors, patients, and Third-Party Administrators (TPAs) to obtain pre-authorization approvals for planned or emergency treatments, ensuring smooth patient admission and claim settlement.

Key Responsibilities:

• Verify patient insurance details and eligibility before admission.
• Prepare and submit pre-authorization forms and required medical documents to the respective TPA/insurance company.
• Coordinate with treating doctors to gather diagnosis, treatment plan, and cost estimates.
• Follow up with insurance companies/TPAs for timely approval of pre-authorization requests.
• Update approval status in the hospital management system and inform the billing/admission desk.
• Handle queries related to pre-authorization approvals or denials.
• Maintain accurate records of all submitted and approved claims.
• Coordinate with the billing team for final claim submission post-discharge.
• Ensure compliance with hospital and TPA protocols.

Required Skills:

• Good communication and coordination skills.
• Knowledge of health insurance policies and TPA procedures.
• Basic understanding of hospital billing and claim documentation.
• Proficiency in MS Office and hospital management software.

Qualification:

• Any graduate.

Job Type: Full-time

Pay: From ₹17,507.55 per month

Benefits:

• Cell phone reimbursement
• Internet reimbursement
• Provident Fund