Assosiate Financial Operations

Responsibilities

• Understanding of Health Insurance terminologies Such as Sum insured, Balance Sum insured , Room eligibility, Capping/Sublimit , Coverage , NME

Explore corporate based insurance eligibility

• 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.
• 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).
• 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.
• Ensure timely resolution of queries for all cases.
• 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.
• 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.

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

• 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 organization's specific requirements.