TPA Billing Executive

Job Summary:

The TPA Billing Executive is responsible for managing cashless and reimbursement billing processes with Third-Party Administrators (TPAs) and insurance companies. The role ensures accurate preparation, submission, and follow-up of claims while maintaining compliance with hospital policies and insurance guidelines.

Key Responsibilities:

Prepare and verify patient files for cashless and reimbursement claims.

Coordinate with TPA coordinators and insurance representatives for pre-authorization and approvals.

Submit hospital bills, discharge summaries, and other required documents to TPAs/insurance companies.

Track claim status, resolve queries, and ensure timely payments.

Maintain records of all claim submissions, approvals, and settlements.

Reconcile TPA/insurance payments with hospital accounts.

Handle claim rejections and re-submissions as required.

Prepare daily and monthly TPA billing reports.

Ensure compliance with NABH and hospital billing policies.

Communicate effectively with patients regarding insurance coverage, documents required, and claim status.

Required Skills & Competencies:

Strong knowledge of TPA billing process and insurance documentation.

Familiarity with hospital billing software (e.g., Medsys, HIS, Tally, etc.).

Excellent communication and coordination skills.

Detail-oriented with strong analytical and problem-solving ability.

Good knowledge of MS Office (Excel, Word).

Qualifications & Experience:

Education: Graduate in Commerce / Healthcare Administration / Hospital Management.

Experience: 1–3 years in hospital TPA billing or insurance coordination.

Preferred: Knowledge of NABH documentation and TPA panel operations.

Job Types: Full-time, Fresher

Pay: ₹10,000.00 - ₹15,000.00 per month

Work Location: In person