About this role
Key Responsibilities: ● Insurance Eligibility Check - Understanding of Health Insurance terminologies Such as Sum insured, Balance Sum insured , Room eligibility, Capping/Sublimit , Coverage , NME - Explore corporate based insurance eligibility ● Pre-Auth Document Validation and Adjudication: - Validate and adjudicate pre-authorization documents. - Ensure all necessary documents are shared with the hospital and that pre-authorization is raised and followed up on effectively. ● Approval and Communication: - Update the internal tool once approval is received from the hospital. - Provide financial counseling to patients as needed, in coordination with the CB (Customer/Billing). ● Hospital Alignment: - Ensure proper alignment with hospitals to avoid miscommunication. - Confirm that the hospital conducts financial counseling, obtains patient consent, and shares the signed copy with the MB Financial Operations team. ● Query Resolution: - Ensure timely resolution of queries for all cases. ● Pre-Auth and Claim Rejections: - Share a list of all pre-auth rejection cases with the IS TLs for cash and EMI counseling. - For claim rejection cases, persuade patients to opt for cash (first preference) or EMI options, and explain these options to both the CB and the patient, if required. ● Discharge Process - Carefully review discharge documents before sharing them with the TPA to ensure room eligibility, tariff accuracy, and genuine billing. - Address TPA queries promptly and provide clear justifications to minimize repeated or multiple queries. - Ensure that hospitals collect out-of-pocket (OOP) payments as per the discharge approval to avoid excess payments. ● Monitoring and Communication: - Monitor WhatsApp groups and emails for any concerns raised by hospitals and the Inside Sales Team. - Assist Inside Sales in document collection and sharing, ensuring cases are properly raised in Lead Square. Basic Requirements: Medical Background: Understanding of medical terminology and procedures. Experience in Hospital Billing and Insurance: Familiarity with hospital billing processes and insurance claims. TPA Insurance SPOC: Experience as a single point of contact for TPA insurance processes. Preferred Qualifications: - Strong communication and interpersonal skills. - Ability to work collaboratively with hospitals, patients, and internal teams. - Proficiency in using financial and healthcare management tools. - Attention to detail and problem-solving skills. - This JD outlines the responsibilities and qualifications for a Senior Associate role focused on -pre-authorization and cashless processes in financial operations. Adjust the details as needed to fit your organization's specific requirements.