Health Department jobs in Uttar Pradesh

Key Responsibilities1. Patient Registration & Eligibility Verification

• Verify beneficiary eligibility through the Ayushman Bharat portal.
• Ensure Aadhaar, Ayushman Card, and other identity documents are valid.
• Assist patients with beneficiary verification and pre-authorization requirements.
• Coordinate with the Ayushman Mitra for smooth patient registration.

2. Pre-Authorization

• Prepare and submit pre-authorization requests as per package guidelines.
• Coordinate with treating consultants for clinical documentation.
• Follow up with the State Health Agency (SHA)/Insurance Company for timely approvals.
• Ensure all required approvals are obtained before treatment whenever applicable.

3. Billing & Package Management

• Prepare bills strictly according to approved AB-PMJAY package rates.
• Ensure correct package selection and coding.
• Verify all investigations, implants, consumables, and procedures are billed as per scheme guidelines.
• Prevent duplicate or non-permissible billing.

4. Claim Preparation & Submission

• Compile complete claim files with all mandatory supporting documents.
• Upload claims on the BIS/TMS portal within the prescribed timelines.
• Ensure claims are complete, accurate, and compliant before submission.
• Maintain records of submitted claims and acknowledgements.

5. Claim Follow-up & Settlement

• Track claim status on the portal.
• Follow up for pending approvals and claim settlements.
• Resolve deficiencies, objections, and query cases promptly.
• Coordinate with insurance companies, TPAs, and State Health Agency officials for claim resolution.

6. Documentation & Compliance

• Ensure all clinical and billing documents are complete and properly signed.
• Maintain physical and electronic claim records.
• Ensure compliance with National Health Authority (NHA) and State Health Agency guidelines.
• Stay updated on revised package rates, circulars, and operational guidelines.

7. Coordination

• Coordinate with:
• Treating Consultants
• Nursing Department
• Medical Records Department (MRD)
• Pharmacy
• Diagnostics
• Finance Department
• Ayushman Mitra
• Insurance Companies/TPAs
• State Health Agency (SHA)

8. MIS & Reporting

• Prepare daily, weekly, and monthly MIS reports covering:
• Patient registrations
• Pre-authorizations
• Claims submitted
• Claims approved/rejected
• Pending claims
• Deficiency cases
• Payments received
• Outstanding receivables

9. Audit Support

• Provide claim documents during internal and external audits.
• Ensure compliance during NHA, SHA, insurance, and hospital audits.
• Assist in corrective actions for audit observations.

Pay: ₹20,000.00 - ₹38,000.00 per month

Benefits:

• Cell phone reimbursement
• Flexible schedule

Work Location: In person