TPA Co-ordinator

Job Purpose: The TPA (Third Party Administrator) Coordinator is responsible for handling all documentation, communication, and coordination related to TPA/insurance patients. This includes pre-authorization, claim submissions, and ensuring smooth patient experience through insurance processes Key Responsibilities: 1. Pre-Authorization & Admission: Verify insurance coverage and eligibility for incoming patients. Coordinate with TPA/insurance companies for pre-authorization approvals. Guide patients and attendants about documentation and TPA process. Maintain accurate admission records of TPA patients. 2. Documentation & Claim Process: Prepare and submit timely pre-authorization, enhancement, and final bill claim documents. Coordinate with the billing department for correct costing and supporting documents. Ensure all forms, discharge summaries, and investigation reports are complete and attached with claims. 3. Coordination & Communication: Act as a liaison between the hospital, patients, and TPA companies. Follow up regularly on claim status until final settlement. Communicate with TPA officials for clarifications, shortfalls, or denials. Keep the patient and family informed about claim status and approvals. 4. Discharge & Billing: Coordinate discharge of TPA patients only after final approval or required payment. Ensure completion of discharge formalities in coordination with the billing team. 5. Reporting & Compliance: Maintain daily TPA admission, discharge, and claim status reports. Ensure compliance with TPA policies, IRDAI regulations, and hospital SOPs. Maintain all records for audit purposes. Key Skills & Competencies: Good communication and interpersonal skills Attention to detail and accuracy in documentation Basic knowledge of hospital billing and insurance process Ability to handle pressure and coordinate with multiple departments Proficiency in MS Office (Excel, Word) and hospital software systems Qualifications & Experience: Graduate in any discipline (Healthcare background preferred) 2–4 years of experience as TPA Coordinator or similar role in a hospital setup Experience in a surgical/Proctology or daycare hospital is an added advantage Working Hours: Full-time, including weekends/holidays based on patient requirements Job Type: Full-time Pay: ₹18,000.00 - ₹22,000.00 per month Schedule: Day shift Weekend availability Work Location: In person