Walk-in || Billing Executive

Core Responsibilities1. CGHS (Central Government Health Scheme) Process Management

• Eligibility & Verification: Validate CGHS cards, referral letters, and doctor prescriptions for incoming patients. [1]
• Package Rate Compliance: Ensure all treatments, investigations, and room rents strictly adhere to prescribed CGHS rates and guidelines. [1]
• Documentation & Submission: Prepare itemized CGHS bills, discharge summaries, emergency certificates, and supporting records for direct submission or reimbursement claims. [1, 2]
• Query Handling: Address objections or audit queries raised by CGHS authorities or government departments. [1]

2. Insurance & TPA (Third Party Administrator) Billing

• Pre-Authorizations: Coordinate with insurance companies and TPAs for cashless treatment approvals from admission to discharge.
• Claim Submission: Compile final hospital bills, diagnostic reports, and physician notes, then submit them within stipulated timelines.
• Follow-ups & Reconciliations: Track pending insurance claims, handle claim rejections/short-settlements, and manage resubmissions.
• Patient Guidance: Explain estimated costs, deductibles, co-pays, and non-payable items clearly to patients and their families. [1, 2]

3. Cash / General Billing & Operations

• IPD/OPD Billing: Generate accurate cash, credit, and corporate bills for general walk-in or self-pay patients. [1, 2]
• Collections & Receipts: Supervise cash/card/UPI collections, verify payment receipts, and reconcile daily cash registers. [1]
• Pending & Unposted Charges: Monitor open/unposted charges, discharge clearances, and advance adjustments before patient discharge