Ayushman Billing Executive

Role & responsibilities

• Manage end-to-end PMJAY/Ayushman Bharat portal operations.
• Verify patient eligibility and package selection as per scheme guidelines.
• Review medical records and ensure all required documents are complete before claim submission.
• Validate that the selected treatment package matches the diagnosis, procedure, and supporting clinical documents.
• Coordinate with doctors, nursing staff, billing, TPA, and medical records teams for claim completion.
• Submit pre-authorizations, discharge requests, and final claims within prescribed timelines.
• Track pending authorizations, queries, deficiencies, and claim settlements.
• Resolve portal queries and coordinate for claim resubmissions whenever required.
• Ensure compliance with PMJAY, state health schemes, and hospital SOPs.
• Maintain accurate records and generate MIS reports related to claims and portal performance.
• Guide and monitor the portal operations team to ensure smooth workflow.

Preferred candidate profile

• Previously handled complete PMJAY claim operations independently.
• Familiar with package approvals, claim settlements, audits, and deficiency management.
• Strong attention to detail with the ability to ensure high claim acceptance rates.

Eligibility

• Graduate in any discipline (Healthcare/Hospital Administration preferred).
• 26 years of relevant experience in PMJAY or government health scheme claim management.
• Experience working in a hospital is preferred.