Medical Doctors

Job description: The Quality A. Manager Hospital shall support the TPA processing department of AYU Health by managing the entire TPA Operation of the entire organization. Must be maintaining good interpersonal relations with insurance companies and patients/attendants. Have to ensure, post discharge insurance queries are dealt within the timeline. Key Job Responsibilities: - Ensure smooth administration of the department to deliver good quality and timely in - patient services on a daily basis. - Coordinate with various consultants for all inpatients billing related services and be one point of contact for them for their queries related to the patient’s bills and their shares. - Provide quality customer care services by faster resolution of staff/ customers and design, implement and improve the processes of customers/ patient handling - Ensure proper escalation of customer grievances - Prepare MIS reports and communicate the same to the management - Follow up and analyze the daily discharge report for improving on the discharge time - Coordinate with various departments to correct the processes leading to delays - Provide Medical opinion for Health Insurance Claims - Processing of Cashless Requests & Health Insurance Claim Documents - Proficient with medical terms & systems. - Understanding of Policy terms & conditions & Various Protocols / Guidelines - Understanding of Claims adjudication / Claims Processing - Maintaining & Ensuring Standard Operating Procedures & Protocols - Ailment Wise ICD & Procedure Coding - Manage volumes effectively & efficiently to maintain Turnaround time of processing cases - VIP Claims Processing and TAT Maintenance - Processing Error to be maintained < 0.25% - Claim Case Management / Cost Management Qualification: Applicants must possess at least a graduation degree in BAMS / BHMS /MBBS etc. (BDS to be avoided) along with Masters in Hospital Administration/Health Management. **Experience**: - At least 3-5 years experience in Claims processing/ TPA documentation process. - Good Excellent oral and written communication, negotiation and decision-making skills. - Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities. Desirable: - Understand enterprise architecture in health care and public health organizations - Knowledge of health insurance and computers. - Well versed with medical terminologies. Skills and Competencies: - Knowledge of Government Legislations and policies are essential; - In depth knowledge of TPA Platform Transitions on premises or cloud from Discovery, Build/Develop, UAT to Go-Live phase. - Built a product from scratch or nascent stage - Solution oriented with strong P&L background and tech experience - Own product strategy, roadmap, outcomes and execution for the product lines built specifically for hospitals i.e., Billing and Claims platform - Ensure products created enable solution leaders to create multiple end-use scenarios with limited or no technology interventions **Salary**: ₹500,000.00 - ₹1,200,000.00 per year **Benefits**: - Health insurance - Provident Fund Schedule: - Day shift Ability to commute/relocate: - Bangalore, Karnataka: Reliably commute or planning to relocate before starting work (required) Application Question(s): - Do have experience in Insurance Claims ? - Do you have BHMS/BUMS/BAMS/BDS/MBBS qualification ? **Education**: - Doctorate (preferred) **Speak with the employer** +91 8123627892 - Health insurance