TPA Co-ordinator

TPA Coordinator acts as a bridge between the hospital, insurance companies, and patients, handling all matters related to cashless insurance claims, pre-authorizations, and reimbursements. They ensure smooth processing of documents and compliance with TPA policies for both insured patients and the hospital.

Key Roles & Responsibilities

Insurance Processing

• Facilitate pre-authorization for cashless treatments by submitting medical documents to TPAs.
• Track approval status and communicate decisions to patients and billing team.
• Handle reimbursement cases by preparing and submitting proper documentation to insurance companies.

Documentation & Coordination

• Collect and verify required documents from patients (ID proof, insurance card, policy documents, etc.).
• Coordinate with doctors and departments to get accurate treatment details and discharge summaries.
• Submit final bills and medical records to TPA for settlement.

Patient Interaction

• Explain the insurance claim process to patients and their families.
• Help patients choose eligible insurance packages or inform them about exclusions.
• Handle patient queries or grievances related to insurance.

Billing & Claims Follow-Up

• Work closely with the billing department to prepare and finalize claims.
• Follow up with TPA for pending or rejected claims.
• Maintain records of all claims filed, approvals, rejections, and payments received.

Compliance & Audit

• Ensure compliance with IRDAI (Insurance Regulatory and Development Authority of India) and hospital policies.
• Prepare reports for hospital management or audits as needed.

Skills Required

• Knowledge of medical insurance processes
• Familiarity with hospital billing software (e.g., MediAssist, MedNet, FHPL, HealthIndia)
• Good communication and interpersonal skills
• Attention to detail in documentation
• Ability to handle pressure and coordinate across departments
• Basic medical terminology (useful when handling diagnosis/procedures)

Qualification

• Minimum: Graduate (any stream, preferably B.Com, BBA, or BA)
• Preferred: Diploma or certification in Hospital Administration, TPA, or Medical Billing
• Basic computer and typing skills are essential
• Previous experience in hospital front office or billing is a plus

Typical Work Environment

• Hospital Front Office / Insurance Desk

Job Types: Full-time, Permanent

Pay: From ₹20,000.00 per month

Work Location: In person