Billing / Insurance / TPA Execuive

Job Summary:

The TPA Executive is responsible for handling all Third Party Administrator-related activities in the hospital including insurance claim processing, documentation, coordination with insurance companies, and ensuring timely approvals and settlements.

Key Responsibilities:

• Patient Admission:
• Verify patient insurance details at the time of admission.
• Facilitate cashless admission by coordinating with TPA/insurance companies.
• Maintain proper documentation for pre-authorization.
• Documentation and Claim Processing:
• Prepare and submit pre-authorization and final claim documents to TPAs/Insurance Companies.
• Ensure timely submission of all relevant medical documents and bills.
• Follow up on pending claims and approvals.
• Coordination:
• Communicate with consultants/doctors for medical inputs required for pre-authorizations and claim processing.
• Act as a liaison between the hospital and insurance/TPA representatives.
• Discharge and Final Billing:
• Ensure timely discharge approvals from TPA/Insurance.
• Coordinate for final settlement of cashless claims.
• Inform patient/family in case of any shortfall or rejection in claim amount.
• MIS and Reporting:
• Maintain and update TPA MIS (claim status, approvals, rejections, payments).
• Report discrepancies, delays, or issues to management for timely action.
• Compliance:
• Ensure compliance with IRDAI norms and hospital policies.
• Maintain confidentiality of patient and financial information.

Qualifications:

• Graduate in any stream (preferably commerce or healthcare).
• Minimum 1-5 years of experience in TPA/Insurance desk in a hospital.

Job Types: Full-time, Permanent

Pay: ₹30,000.00 - ₹40,000.00 per month

Benefits:

• Health insurance
• Provident Fund

Work Location: In person