
Insurance Coordinator
3 days ago
Department: Insurance
Reports To: HOD Insurance
Job Summary:
The Insurance Coordinator is responsible for managing all aspects of patient insurance processes, including verification, preauthorization, documentation, claims submission, and follow-up. The role ensures smooth coordination between patients, insurance companies, and hospital departments to facilitate timely and accurate claim settlements.
Key Responsibilities:
Insurance Verification & Preauthorization:
Verify patients insurance coverage, eligibility, and policy details before admission or treatment.
Obtain preauthorization from insurance providers for procedures, surgeries, and inpatient admissions.
Documentation & Coordination:
Ensure all required patient and clinical documents are complete and accurately submitted to the insurer.
Liaise with consultants, doctors, and billing departments for clarification and supporting documents.
Claims Management:
Prepare and submit insurance claims within the specified timelines.
Track claim status and follow up with insurance companies to resolve pending or denied claims.
Patient Communication:
Explain insurance processes, coverage limits, and exclusions to patients and their families.
Assist patients with queries regarding insurance approvals and claim settlements.
Compliance & Reporting:
Maintain accurate records of insurance correspondence and claim logs.
- Ensure compliance with hospital policies, TPA (Third-Party Administrator), and regulatory requirements.
- Generate daily, weekly, and monthly insurance reports for management review.
Qualifications & Skills:
- Bachelors degree in Hospital Administration, Commerce, or related field.
- 1 to 3 years of experience in hospital insurance or billing department preferred.
- Good knowledge of health insurance procedures, TPAs, and claim documentation.
- Strong communication and coordination skills.
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