Head TPA Insurance Operations Sterling Addlife

10.0 - 18.0 years

20 - 22 Lacs

ahmedabad

Work from Office

Head TPA Key Responsibility : Insurance Empanelment & Relationship Building : - Identify and target key insurance providers for empanelment to expand the hospital's network. - Lead the process of empanelment, including application, documentation, and site visits. - Develop and maintain strong, collaborative relationships with key personnel at TPA and insurance companies. - Act as the primary point of contact for all insurance-related matters. - Proactively address any issues or concerns raised by TPAs or insurance providers. Price Negotiation with Insurance Companies: - Lead negotiations with insurance companies and TPAs to secure favorable pricing agreements for hospital services. - Conduct thorough analysis of costing and market rates to support negotiation strategies. - Ensure that negotiated rates are accurately implemented in the hospital's billing system. - Regularly review and renegotiate contracts to optimize revenue. Insurance Collection & Recoveries: - Oversee the insurance billing and collection process to ensure timely submission of claims. - Implement strategies to minimize claim rejections and maximize recovery rates. - Monitor outstanding insurance receivables and proactively follow up for timely payments. - Analyze rejection trends and implement corrective actions to improve claim accuracy. - Ensure adherence to all relevant insurance regulations and guidelines. Revenue Cycle Management (Insurance Aspect): - Collaborate with other departments (e.g., billing, finance, medical records) to optimize the end-to-end revenue cycle related to insurance payers. - Identify and implement process improvements to enhance efficiency and reduce revenue leakage. - Stay updated on changes in insurance policies, regulations, and industry best practices. - Provide regular reports on insurance empanelment status, collection performance, and key performance indicators. Qualifications & Experience: - Educational qualifications, e.g., bachelor's degree in business administration, Healthcare Management, or a related field. - 10+ Years of expertise, preferably in a hospital setting managing TPA and insurance relations. - Strong leadership ability of the relationship building - Business Acumen - Negotiation Skills - Proven track record of successful insurance empanelment, price negotiation, and collection recovery. - Strong understanding of healthcare insurance processes, regulations, and billing practices. - Excellent negotiation, communication, and interpersonal skills. - Strong analytical and problem-solving abilities. - Proficiency in relevant software and MS Office Suite.

Posted 3 weeks ago

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