TPA Coordinator-Hospital Experience

Pre-Admission & Admission:

• Collect and verify insurance documents from patients.
• Coordinate with treating doctors for necessary documents (e.g., diagnosis, treatment plan).
• Initiate pre-authorization process with TPA/insurance companies.
• Follow up for approval and ensure timely admission under cashless treatment.

2. During Hospitalization:

• Maintain communication with TPAs for interim approvals/extensions as required.
• Ensure all procedures or treatments are approved and documented properly.
• Maintain accurate records of approvals and patient documents.

3. Discharge Process:

• Submit final bill and discharge summary to the insurance company/TPA.
• Follow up for final approval and inform the billing department.
• Ensure patient discharge only after approval or necessary payment clearance.

4. Post-Discharge & Reimbursement:

• Support patients in submitting reimbursement claims.
• Coordinate with TPA for follow-ups on pending claims.
• Maintain detailed MIS for claim submissions, approvals, rejections, and pending cases.

5. Documentation & Compliance:

• Maintain confidentiality and accuracy in all insurance-related documents.
• Ensure compliance with hospital policies.
• Liaise with internal departments for audits and compliance checks.

Required Skills & Qualifications:

• Graduate in any discipline (preferably in Healthcare or Insurance).
• 2–5 years of experience in TPA/insurance coordination in a hospital setting.
• Good understanding of health insurance processes and documentation.
• Strong communication and interpersonal skills.
• Proficiency in MS Office and hospital information systems (HIS).
• Ability to handle stress and multitask in a fast-paced environment.

Preferred:

• Certification in Hospital Administration or Health Insurance.
• Experience with major TPAs and knowledge of cashless claim platforms.
• 25-30k/month

candidate can call-9630196021, 9425503700

Job Type: Full-time

Work Location: In person