TPA Liaison: Serve as the primary point of contact between the hospital and TPAs, ensuring smooth claims processing and reimbursement. Collaborate with TPAs to verify patient eligibility, approve pre-authorizations, and facilitate smooth discharge procedures. Ensure timely submission of claims, follow up on outstanding claims, and resolve any discrepancies or issues related to TPA reimbursements. Corporate Client Coordination: Act as a liaison for corporate clients, addressing their queries and ensuring employees medical needs are met efficiently. Coordinate with corporate clients to manage employee health programs, including corporate insurance policies, wellness programs, and preventive health check-ups. Assist in the onboarding of corporate clients and ensure smooth setup for hospital services under corporate agreements. Claims Management: Monitor, track, and process claims submitted by patients under TPA and corporate agreements. Ensure all claims meet the required documentation and regulatory standards. Resolve claim issues and disputes in a timely manner, coordinating with both internal departments and external stakeholders. Documentation and Reporting: Maintain accurate records of all communications, claims, approvals, and payments from TPAs and corporate clients. Prepare regular reports on claims processing status, pending approvals, and financial reconciliations for internal and external stakeholders. Ensure all documentation is organized, up-to-date, and compliant with hospital policies and industry regulations. Customer Service: Provide exceptional customer service to patients, TPAs, and corporate clients by addressing inquiries and concerns promptly. Ensure patients and their families understand the process of claiming insurance and managing payments through TPAs or corporate policies. Cross-Functional Collaboration: Work closely with the billing, finance, and medical teams to ensure that patient care is seamless, and claims are processed efficiently. Collaborate with other hospital departments (admissions, discharge, accounts) to resolve any patient-related issues concerning TPA and corporate coverages. Compliance and Regulations: Stay updated with the latest regulations, policies, and procedures related to TPAs, corporate healthcare programs, and insurance claims. Ensure all processes align with the hospitals standards, legal requirements, and industry best practices. Key Skills and Qualifications: Education: Bachelors degree in healthcare management, business administration, or related fields. Experience: 1-2 years of experience in TPA management, corporate healthcare coordination, or insurance claims processing is preferred. Skills: Strong communication and interpersonal skills to interact with TPAs, corporate clients, and internal teams. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and hospital management systems. Ability to handle sensitive and confidential patient information. Attention to detail and strong organizational skills to manage multiple tasks simultaneously. Problem-solving skills to resolve claims and coordination issues. Working Environment: The role typically operates in an office setting within the hospital or remotely, with periodic visits to patient care areas or meetings with external stakeholders. The job may involve working with insurance companies, corporate representatives, and patient families, requiring professional demeanor and strong customer service skills.
