Criticare Asia Multispeciality Hospital & Research Center

Job Responsibilities of a TPA Coordinator (Hospital Billing Department) 1. Patient Admission & Pre-Authorization Verify patient insurance/TPA details at the time of admission. Collect required documents and submit cashless pre-authorization requests to the respective TPA. Communicate approvals, denials, or queries from TPA to patients and concerned departments. Ensure timely follow-up on pending pre-auth approvals. 2. Coordination With TPA / Insurance Companies Act as the primary point of contact between the hospital and TPAs/insurance companies. Respond promptly to TPA queries related to patient treatments, packages, line of treatment, etc. Maintain healthy working relationships with TPA representatives. 3. Billing & Documentation Ensure all medical records, treatment notes, investigation reports, and bills are accurate and complete. Prepare final bills for insured patients as per TPA tariff and agreements. Check admissibility of charges based on TPA policies and guidelines. 4. Cashless & Reimbursement Processing Process cashless discharge approvals by sending final bill and discharge summary to TPA. Assist patients in documentation for reimbursement claims. Ensure all claim forms are correctly filled, signed, and stamped. 5. Discharge Coordination Coordinate with doctors, nurses, and billing team to prepare discharge summary and documentation. Follow up with TPA for final authorization to avoid discharge delays. Communicate approved and non-approved items to patients clearly. 6. Claim Submission & Follow-Up Submit completed claims to TPA within timelines. Track and follow up on claim status to avoid rejections and delays. Re-submit additional documents or justifications requested by TPA. 7. Denial & Query Management Handle claim rejections, short-settlements, and TPA queries professionally. Coordinate with medical team to provide clarifications or additional documents. Maintain records of denials and initiate corrective actions. Contact person : Human Resources Contact Number : 9930400992 Email Address : najma.shaikh@criticareasiahospital.com