Assosiate Financial Operations

Key Responsibilities:● Insurance Eligibility Check- Understanding of Health Insurance terminologies Such as Sum insured, Balance Suminsured , 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-authorizationis 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, andshares 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 EMIoptions, 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 roomeligibility, tariff accuracy, and genuine billing.- Address TPA queries promptly and provide clear justifications to minimize repeated ormultiple queries.- Ensure that hospitals collect out-of-pocket (OOP) payments as per the dischargeapproval to avoid excess payments.● Monitoring and Communication:- Monitor WhatsApp groups and emails for any concerns raised by hospitals and theInside Sales Team.- Assist Inside Sales in document collection and sharing, ensuring cases are properlyraised in Lead Square.Basic Requirements:Medical Background: Understanding of medical terminology and procedures.Experience in Hospital Billing and Insurance: Familiarity with hospital billing processesand insurance claims.TPA Insurance SPOC: Experience as a single point of contact for TPA insuranceprocesses.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 rolefocused on -pre-authorization and cashless processes in financial operations. Adjust thedetails as needed to fit your organization's specific requirements.