Walkin - Insurance CGHS Process -(2-3 years Hospital Experience)

Key Responsibilities

1. Insurance & TPA Coordination

• Coordinate with TPAs (Third Party Administrators) and insurance companies for claim processing.
• Handle cashless approvals, pre-authorizations, and claim submissions.
• Follow up for approvals, queries, and claim settlements.

2. CGHS Process Management

• Manage CGHS patient documentation, eligibility verification, and approval process.
• Ensure compliance with CGHS guidelines and package rates.
• Prepare and submit CGHS bills and supporting documents.

3. Billing & Documentation

• Prepare accurate insurance and CGHS bills as per hospital policies.
• Maintain proper documentation for claims, approvals, and rejections.
• Handle discrepancies and resubmissions.

4. Patient Coordination

• Guide patients and attendants regarding insurance and CGHS procedures.
• Explain billing, approvals, and required documents clearly.

5. Claims Follow-up & Reconciliation

• Track pending claims and ensure timely settlement.
• Reconcile payments received from insurance/CGHS.
• Maintain reports on pending, approved, and rejected claims.

6. Compliance & Audit

• Ensure adherence to hospital policies, insurance norms, and CGHS regulations.
• Support internal and external audits.
• Maintain confidentiality of patient and financial data.

Qualifications & Experience

• Graduate in any discipline (commerce/healthcare management preferred).
• 2-4 years of experience in hospital insurance/TPA/CGHS processing preferred.
• Knowledge of medical billing and insurance procedures.