Ayushman TPA HEAD

Shree Jagannath Charitable Cancer Hospital

5 - 6 years

5 - 6 Lacs

ghaziabad

Posted:5 days ago| Platform:

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Skills Required

health claims claims health insurance hospital health insurance

Work Mode

Work from Office

Job Type

Full Time

Job Description

Position:

Key Responsibilities:

Oversee all Ayushman Bharat scheme operations, including patient registration, pre-authorization, and claim submission.
Coordinate with TPA officials, insurance companies, and empaneled hospitals for smooth claim processing.
Verify treatment packages, patient eligibility, and documentation as per NHPM guidelines.
Ensure timely claim submission, query resolution, and settlement tracking.
Maintain records and prepare daily, weekly, and monthly MIS reports.
Train billing and front desk staff on Ayushman procedures and software updates.
Handle audits and inspections from Ayushman / State Health Authority.
Monitor rejected and pending claims, and take corrective actions.
Liaise with hospital management to ensure compliance with Ayushman norms.

Skills Required:

Deep understanding of Ayushman Bharat / PM-JAY guidelines.
Expertise in TMS (Transaction Management System) and claim portals.
Strong communication, coordination, and analytical abilities.
Proficiency in Excel and hospital billing systems.

Qualification:

Graduate or Postgraduate in Healthcare Administration / Hospital Management / MBA (preferred).
Relevant certification in health insurance or TPA management is an advantage.

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