Medical Officer - Finance
- Manipal Hospitals
- 3 - 6 years
- Bengaluru
- 1 month ago
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Job Description
Job Summary:
The Medical Officer Billing & TPA acts as a vital link between the clinical and billing teams, ensuring accurate medical documentation, coding, and justification of procedures for insurance claims and patient billing. The role involves reviewing patient files, validating treatment details, supporting pre-authorization and final billing, and ensuring compliance with insurance and hospital policies.
Roles & Responsibilities:
1. Medical Review & Documentation
- Verify diagnosis, procedures, investigations, and treatment details in patient case files for billing accuracy.
- Ensure all medical documentation, prescriptions, and consultant notes are complete before claim submission.
- Liaise with doctors and nursing teams to obtain clarifications on clinical details when required.
2. Insurance Coordination (TPA)
- Prepare and review pre-authorization requests, discharge summaries, and supporting documents for TPA approval.
- Coordinate with TPA executives, insurance coordinators, and consultants for timely updates and approvals.
- Ensure medical justifications are clearly documented for all high-value and non-package procedures.
- Support the billing team in denial management and resolving claim queries.
3. Billing Support
- Review and validate patient bills to ensure alignment with diagnosis, procedures, and treatment protocols.
- Cross-check package inclusions and exclusions, consumables, and service codes before final billing.
- Assist in monitoring discharge TAT by ensuring prompt medical clearance for billing closure.
4. Compliance & Quality
- Ensure all TPA-related documents comply with IRDA, NABH, and hospital audit standards.
- Participate in internal audits and provide necessary medical clarifications to finance and quality teams.
- Maintain confidentiality of patient and financial data at all times.
5. Communication & Coordination
- Act as the liaison between clinical, billing, and TPA departments for smooth case flow.
- Communicate with patients and families to explain insurance-related medical queries when needed.
- Escalate discrepancies or delays to the Billing / TPA Manager promptly.
Skills & Competencies:
- Strong understanding of hospital billing, TPA processes, and insurance documentation.
- Clinical knowledge to interpret medical records accurately.
- Excellent communication and coordination skills.
- Detail-oriented with strong analytical and documentation abilities.
- Knowledge of hospital management systems (HIS) and MS Office.
Job Classification
Industry: Medical Services / HospitalFunctional Area / Department: Administration & FacilitiesRole Category: AdministrationRole: Administration - OtherEmployement Type: Full timeContact Details:
Company: Manipal HospitalsLocation(s): Bengaluru
Keyskills: Medical Officer Insurance Claims Claims Processing
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Manipal Hospitals
As a pioneer in healthcare, Manipal Hospitals is among the top healthcare providers in India serving over 5 million patients annually. Today we stand as an integrated network with a pan-India footprint of 33 hospitals across 17 cities with 9,500 beds, and a talented pool of over 5,000 doctors and an...
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