TPA Coordinator

1. Claim Processing and Management: Accurate and timely claim submission: Ensuring all required documentation is complete and submitted to the insurance company or TPA within the specified timeframe. Claim verification and review: Checking claim details, verifying patient insurance coverage, and identifying any discrepancies or denials. Follow-up and resolution: Contacting the TPA or insurance company to address any issues, such as denied claims, and ensuring they are resolved. Maintaining accurate records: Keeping detailed records of all claims, including documentation, communication, and claim status. 2. Cashless Claim Management: Verification of TPA cards and policies: Checking the patient's TPA card, photo ID, and insurance policy to ensure coverage. Pre-authorization and consent: Assisting patients with filling out necessary forms and obtaining pre-authorization from the TPA. Communication with TPA: Contacting the TPA to request cashless approval and obtaining necessary documents. Patient support and guidance: Explaining the cashless process to patients and providing guidance on the documentation required. 3. Liaison and Communication: Hospital-TPA liaison: Serving as a bridge between the hospital and the TPA to facilitate smooth communication and resolution of issues. Patient communication: Providing clear and concise information to patients regarding their insurance claims, eligibility, and status. Collaboration with other departments: Working with billing, finance, and medical staff to ensure accurate and efficient claim processing. 4. Data Management and Reporting: Maintaining patient records: Keeping patient records updated with insurance information, claim status, and relevant details. Generating reports: Creating reports on claim processing, reimbursement rates, and other relevant data. Staying updated: Keeping abreast of changes in insurance policies and regulations. 5. Other Responsibilities: Resolving billing issues: Discussing discounts with third-party payers and settling claims. Providing financial counseling: Explaining financial aspects of treatment, including costs and insurance coverage. Ensuring compliance: Adhering to regulatory requirements and internal processes for claim processing. Providing customer support: Offering assistance to patients and their families regarding their insurance claims. In essence, a TPA coordinator plays a crucial role in ensuring smooth and efficient insurance claim processing, providing support to patients, and facilitating seamless communication between the hospital, patients, and insurance providers. Job Type: Full-time Pay: ₹12,000.00 - ₹18,000.00 per month Benefits: Cell phone reimbursement Health insurance Provident Fund Schedule: Day shift Morning shift Night shift Rotational shift Work Location: In person