Senior Assistant - Billing IP

Key Responsibilities

1. Insurance & TPA Coordination

• Verify patient insurance eligibility, policy details, coverage limits, exclusions, and applicable terms at the time of admission.
• Coordinate with Insurance Companies and Third-Party Administrators (TPAs) for cashless hospitalization requirements.
• Prepare and submit pre-authorization requests with required patient and clinical documentation.
• Follow up on pending pre-authorizations, approvals, queries, and enhancement requests.
• Coordinate with doctors and clinical departments to obtain additional medical information required by the insurer/TPA.
• Keep patients/attendants informed regarding approval status, exclusions, co-payment, non-medical expenses, and other payable amounts as applicable.
• Maintain proper records of approvals, denial/rejection communications, and insurance-related correspondence.

2. Hospital Billing

• Prepare and verify IP/OP patient bills as per approved hospital tariff and applicable payer agreements.
• Ensure accurate posting of room charges, investigations, procedures, pharmacy, consumables, professional charges, and other applicable services.
• Verify that all services provided to the patient are appropriately captured before final billing.
• Identify billing discrepancies and coordinate with concerned departments for correction.
• Process package, corporate, insurance, TPA, and cash patient billing as applicable.
• Ensure tariff/package rates and approved discounts are applied only as per authorized processes.
• Support interim and final bill preparation.

3. Discharge Billing & Coordination

• Monitor planned discharges and initiate billing activities in advance wherever possible.
• Coordinate with Pharmacy, Nursing, Diagnostics, OT, Cath Lab, Consultant Secretaries, and other departments for bill closure.
• Prepare the final bill after ensuring all relevant charges and credits are incorporated.
• Submit the final bill and required documents to Insurance/TPA for final authorization.
• Follow up for final approval to facilitate timely discharge.
• Coordinate collection of patient payable amounts, co-payments, deductibles, exclusions, or non-covered expenses as applicable.
• Support reduction of avoidable discharge delays related to billing or insurance processing.

4. Insurance Documentation

• Ensure completeness and accuracy of documents required for cashless/insurance processing.
• Verify availability of relevant documents such as:
  • Pre-authorization approval
  • Enhancement approvals
  • Final authorization
  • Discharge summary
  • Final bill and bill break-up
  • Investigation reports
  • Pharmacy/implant details where applicable
  • Claim forms and supporting documents
• Maintain documentation according to organizational confidentiality and record-management requirements. Information management is one of the core domains covered in the current NABH Accreditation Standards for Hospitals. [portal.nabh.co]

5. Claim & Query Support

• Coordinate with the Insurance/Claims team for submission of required documents.
• Respond to TPA/insurance queries by coordinating with concerned hospital departments.
• Track pending documents and ensure timely submission.
• Support correction and resubmission of documents in case of deficiencies.
• Escalate unresolved authorization, denial, or billing issues to the reporting authority.

6. Patient & Attendant Handling

• Explain billing and insurance processes clearly and professionally to patients and attendants.
• Address queries regarding bill details, insurance authorization, patient payable amounts, and discharge settlement.
• Handle billing concerns courteously and escalate disputes or complaints appropriately.
• Maintain patient confidentiality, dignity, and professional communication.
• Coordinate with Patient Relations/Operations for unresolved patient service issues.

7. Corporate & Payer Billing Support

• Follow approved tariffs and contractual terms for Insurance/TPA/Corporate patients.
• Verify applicable packages, agreed rates, discounts, and credit arrangements before finalization.
• Coordinate with Finance/Accounts for reconciliation wherever required.
• Highlight discrepancies between hospital tariffs, payer approvals, or agreed contractual rates to the concerned authority.

8. MIS & Reconciliation

• Maintain daily records of admissions, insurance approvals, pending authorizations, enhancements, discharges, and billing status.
• Prepare required daily/weekly/monthly Insurance & Billing MIS.
• Track pending cashless cases and unresolved payer queries.
• Support reconciliation of bills, approvals, receipts, and outstanding amounts.
• Ensure accurate entry of billing and insurance information in HIS/ERP systems.

9. Quality & Compliance

• Follow hospital SOPs, billing policies, payer guidelines, and authorization processes.
• Ensure confidentiality of patient, medical, insurance, and financial information.
• Maintain records required for internal/external audits.
• Support accreditation and quality-related documentation applicable to the department.
• Escalate billing errors, documentation deficiencies, and potential revenue leakage to the reporting manager.
• Maintain accuracy and transparency in all billing and insurance transactions.

10. Additional Responsibilities

• Support department requirements during high patient volumes and peak discharge hours.
• Coordinate with other departments for timely closure of billing and insurance-related issues.
• Participate in departmental meetings, training, audits, and process-improvement initiatives.
• Perform any other responsibilities related to billing, insurance, patient coordination, finance support, or hospital operations assigned by the Reporting Manager or Hospital Management from time to time, based on organizational requirements.

Key Performance Indicators (KPIs)