Ayushman Operator

ob Description – Ayushman Operator / TPA Executive

Department: Ayushman Bharat / TPA / Insurance

Location: RoopJeevan Hospital, Raipur

Employment Type: Full-Time

Role Overview

We are looking for a proactive and detail-oriented Ayushman Operator / TPA Executive to manage all Ayushman Bharat (PM-JAY), government schemes, private insurance, and TPA-related activities. The candidate will ensure timely approvals, accurate documentation, smooth patient coordination, and prompt claim settlement. 

Key Responsibilities

Verify patient eligibility under Ayushman Bharat and other government schemes.

Complete patient registration, package selection, and portal entries.

Process pre-authorizations, enhancements, and final claim submissions.

Coordinate with doctors, nursing, billing, MRD, OT, and accounts for required documentation.

Upload clinical documents, investigation reports, operative notes, discharge summaries, and bills on the portal.

Follow up on pending approvals, claim queries, deficiencies, and rejections.

Coordinate with TPAs and insurance companies for cashless approvals and settlements.

Ensure accurate billing as per package guidelines and hospital policies.

Counsel patients and relatives regarding Ayushman/insurance processes.

Maintain claim trackers, MIS reports, and departmental records.

Ensure compliance with Ayushman, insurance, and hospital SOPs.

Support audit activities and maintain complete confidentiality of patient information. 

Eligibility

Graduate in any discipline.

1–3 years of experience in Ayushman Bharat, TPA, Mediclaim, or hospital billing.

Experience with hospital HIS and Ayushman/TPA portals preferred.

Knowledge of medical terminology and hospital workflows.

Skills Required

Excellent documentation and computer skills.

Strong communication and coordination abilities.

Attention to detail and accuracy.

Ability to work under pressure and meet turnaround times.

Good problem-solving and follow-up skills.