TPA Coordinator

1. Job Summary

The Corporate & TPA Coordinator is responsible for managing all activities related to cashless hospitalization, insurance coordination, corporate billing, and liaison with TPAs (Third Party Administrators) and corporate clients. The role ensures smooth patient admission and discharge under insurance/corporate schemes, accurate documentation, timely claims submission, and compliance with hospital policies.

2. Key ResponsibilitiesA. TPA & Insurance Coordination

• Handle all cashless and reimbursement processes for insured patients.
• Verify patient insurance eligibility, policy coverage, and approval limits.
• Submit pre-authorization requests and follow up with TPAs for timely approvals.
• Maintain updated knowledge of various TPA policies, exclusions, and procedures.
• Coordinate with medical teams to prepare documents required for claims.

B. Corporate Client Coordination

• Manage relationships with corporate clients associated with the hospital.
• Facilitate admission, treatment approvals, and discharge formalities for corporate patients.
• Prepare and submit corporate bills as per agreed tariffs and contract terms.
• Follow up for outstanding corporate payments and ensure timely collections.

C. Billing & Documentation

• Ensure accurate preparation of insurance/corporate bills.
• Verify all documents including discharge summaries, consultation notes, investigation reports, and pharmacy/consumable bills.
• Submit final bills and claim documents to TPA/corporate in required formats.
• Track claims status and coordinate for approvals, queries, and settlements.

D. Compliance & Audit

• Ensure all insurance processes comply with TPA guidelines and hospital standards.
• Maintain proper records of approvals, payments, and pending claims.
• Coordinate with internal and external audit teams for claim verification.
• Ensure adherence to NABH standards related to insurance billing and documentation.

E. Patient Communication

• Explain insurance and corporate procedures to patients and attendants.
• Guide patients on required documents for reimbursement and discharge.
• Provide support in resolving patient queries related to insurance and billing.

F. Coordination with Internal Departments

• Liaise with doctors, nursing, billing, pharmacy, diagnostics, and administration teams for smooth processing.
• Ensure timely submission of medical documents required by TPAs.

3. Required Qualifications

• Graduate in any discipline (Preferably BBA / B.Com / Healthcare Management).
• Certificate/Diploma in Hospital Administration or Health Insurance preferred.
• Minimum 1–3 years of experience in a hospital TPA/corporate billing desk.

4. Skills & Competencies

• Strong knowledge of insurance/TPA processes and corporate billing.
• Excellent communication and coordination skills.
• Ability to handle documentation and multi-task efficiently.
• Good negotiation and follow-up skills.
• Proficiency in MS Office and hospital management systems (HMS).
• Strong attention to detail and ability to work under deadlines.

5. Behavioural Qualities

• Customer-friendly and patient-centric approach.
• Professional, polite, and empathetic in dealing with patients and clients.
• High integrity and confidentiality in handling patient information.
• Ability to work independently and as part of a team.

6. Work Environment

• Desk-based role with interactions across departments.
• May require extended working hours during peak patient load or audits.

Job Type: Full-time

Pay: ₹20,000.00 - ₹30,000.00 per month

Benefits:

• Provident Fund

Work Location: In person