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As a Hospital TPA Coordinator, you will be responsible for managing the relationships and administrative processes related to third-party administrators, such as insurance companies and managed care organizations. Your role involves facilitating communication, ensuring timely processing of claims, and maintaining compliance with contractual agreements and regulatory requirements.

Responsibilities:

• Claims Processing:
• Receive, review, and process insurance claims submitted by patients or healthcare providers.
• Verify patient eligibility and coverage details with the TPA.
• Ensure claims are submitted accurately and promptly to maximize reimbursement.
• Communication and Coordination:
• Serve as the primary point of contact between the hospital and TPAs.
• Communicate effectively with TPAs to resolve claim issues, denials, and payment discrepancies.
• Collaborate with hospital billing and finance departments to streamline claim processing.
• Contract Management:
• Monitor and enforce contractual agreements with TPAs to ensure compliance.
• Negotiate rates and terms for services provided to insured patients.
• Update and maintain contract documentation and records.
• Documentation and Reporting:
• Maintain accurate records of TPA communications, claims status, and payments.
• Generate reports on claim processing metrics, reimbursement rates, and trends.
• Provide regular updates to hospital management on TPA performance and financial impact.
• Quality Assurance and Compliance:
• Ensure compliance with healthcare regulations and TPA requirements.
• Implement quality assurance measures to minimize claim errors and optimize reimbursement.
• Patient Advocacy:
• Assist patients with understanding their insurance coverage, benefits, and responsibilities.
• Advocate on behalf of patients to resolve insurance-related issues and ensure fair reimbursement.

Job Types: Full-time, Permanent

Pay: ₹8,954.17 - ₹50,119.84 per month

Experience:

• total work: 1 year (Preferred)

Work Location: In person