Patient Admin Executive

Role Overview

Patient Admin Executive at NMC Healthcare. This is a front-line administrative role supporting patient registration, insurance verification, and claims management across the medical facility.

Role Purpose

Deliver efficient patient reception, registration, and insurance administration to ensure smooth patient flow, accurate documentation, and compliance with hospital policies and regulatory standards.

Key Responsibilities

Patient Reception & Flow

• Greet patients upon arrival and direct them to appropriate departments.
• Provide routine information about the hospital when necessary.
• Maintain a safe and clean reception area in compliance with procedures, rules, and regulations.
• Exercises effective interpersonal skills in dealings with department staff, colleagues, and management.

Patient Registration & Documentation

• Confirm and register new patients into the system.
• Enter new patient information and update records in the system.
• Maintain accurate records and high standards of data accuracy.
• Maintain patient and staff confidentiality.
• Ensure correct documentation is attached for claims.

Insurance & Claims Management

• Verify patients' insurance coverage and eligibility.
• Maintain updated records of insurance policies, benefits, and limits.
• Educate patients about their insurance coverage and co-payments.
• Handle patient queries regarding claims, approvals, or reimbursement.
• Maintain accurate records of all insurance claims and payments.
• Keep the pending approval monitoring system updated for next-day follow-up.
• Resolve discrepancies between insurance records and claims.
• Assist in resolving billing discrepancies related to insurance.
• Work closely with the front desk, billing team, and clinical staff to ensure accurate documentation and billing.
• Guide staff to follow correct ICD and CDT codes to avoid claim rejection.
• Coordinate with head office insurance team for escalations when required.
• Keep all insurance records updated and ready for audits and inspections.

Communications & Correspondence

• Check emails daily and respond to queries in a timely manner.
• Answer calls on a regular basis.

Compliance & Quality

• Ensure operations are carried out uniformly according to hospital policies and procedures.
• Strictly adhere to NMC's regulations and policies, especially those related to infection control, patient safety, and JCI.
• Ensure complaints are handled in a structured, timely, and professional manner that is fair, courteous, and respectful of privacy.
• Maintain compliance with insurance rules and clinic policies.
• Stay updated on insurance policies, regulations, and guidelines.
• Support Continuous Quality Improvement and participate in all quality assurance activities of the service.
• Participate in hospital training programs.
• Identify problems and contribute to continuous improvement of department services.

Scheduling & Operations

• Follow the duty schedule as assigned by the team leader or supervisor, which includes different shift timings as per departmental need.
• Accomplish related results as needed and contribute to team effort.

Qualifications & Experience

• College Diploma in any discipline or related field.

Additional Information

• Role includes variable shift timings based on departmental requirements.
• Compliance required with infection control, patient safety, and JCI standards.