Corporate Billing-Hospital

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.

Preferred candidate profile