Assosiate Financial Operations
Share
Job Location:
Monthly Salary:
Posted on:
5 days ago
Vacancies:
1 Vacancy
Job Summary
Key Responsibilities:
Insurance Eligibility Check
- Understanding of Health Insurance terminologies Such as Sum insured Balance Sum
insured Room eligibility Capping/Sublimit Coverage NME
- Explore corporate based insurance eligibility
Pre-Auth Document Validation and Adjudication:
- Validate and adjudicate pre-authorization documents.
- Ensure all necessary documents are shared with the hospital and that pre-authorization
is raised and followed up on effectively.
Approval and Communication:
- Update the internal tool once approval is received from the hospital.
- Provide financial counseling to patients as needed in coordination with the CB
(Customer/Billing).
Hospital Alignment:
- Ensure proper alignment with hospitals to avoid miscommunication.
- Confirm that the hospital conducts financial counseling obtains patient consent and
shares the signed copy with the MB Financial Operations team.
Query Resolution:
- Ensure timely resolution of queries for all cases.
Pre-Auth and Claim Rejections:
- Share a list of all pre-auth rejection cases with the IS TLs for cash and EMI counseling.
- For claim rejection cases persuade patients to opt for cash (first preference) or EMI
options and explain these options to both the CB and the patient if required.
Discharge Process
- Carefully review discharge documents before sharing them with the TPA to ensure room
eligibility tariff accuracy and genuine billing.
- Address TPA queries promptly and provide clear justifications to minimize repeated or
multiple queries.
- Ensure that hospitals collect out-of-pocket (OOP) payments as per the discharge
approval to avoid excess payments.
Monitoring and Communication:
- Monitor WhatsApp groups and emails for any concerns raised by hospitals and the
Inside Sales Team.
- Assist Inside Sales in document collection and sharing ensuring cases are properly
raised in Lead Square.
Basic Requirements:
Medical Background: Understanding of medical terminology and procedures.
Experience in Hospital Billing and Insurance: Familiarity with hospital billing processes
and insurance claims.
TPA Insurance SPOC: Experience as a single point of contact for TPA insurance
processes.
Preferred Qualifications:
- Strong communication and interpersonal skills.
- Ability to work collaboratively with hospitals patients and internal teams.
- Proficiency in using financial and healthcare management tools.
- Attention to detail and problem-solving skills.
- This JD outlines the responsibilities and qualifications for a Senior Associate role
focused on -pre-authorization and cashless processes in financial operations. Adjust the
details as needed to fit your organizations specific requirements.
Key Skills
- Financial Services
- Financial Models
- Account Management
- General Ledger Accounts
- ERP
- Payroll
- External Auditors
- Customer Relationships
- Credit Card
- Financial Statements
- Business Units
- Annual Budget
- Income
- New Clients
- Financial Management
About Company
MediBuddy is one of the best (cashless) healthcare providers in India. At MediBuddy you can book Health check packages, online lab tests, online medicines, online doctor consultation, teleconsultation, dental consultation and many more. You can also book outpatient, inpatient, and wel ... View more
