Tpa Executive

Job Description

Role & responsibilities : Patient Support and Coordination: Assisting patients and their families with understanding insurance policies and procedures. Coordinating with patients, hospital staff, and insurance companies to ensure smooth and efficient treatment. Ensuring patients are eligible for cashless treatment. Providing updates on claim status to patients and their families. Claims Processing: Verifying patient eligibility and insurance coverage. Preparing and submitting claims to insurance companies. Tracking the status of claims and following up with insurance companies. Ensuring accurate and timely processing of claims. Pre-Authorization and Approvals: Obtaining pre-authorization for procedures and treatments. Ensuring all necessary documentation is submitted to insurance companies. Following up on approvals and denials. Compliance and Regulations: Ensuring compliance with relevant laws, regulations, and industry standards. Staying updated with changes in healthcare regulations and insurance policies. Maintaining accurate records and documentation. Other Responsibilities: Handling billing inquiries and resolving billing issues. Maintaining a positive and professional relationship with patients, staff, and insurance companies. May be involved in value-added services such as ambulance assistance and wellness programs. Qualifications and Skills: Strong understanding of insurance policies and procedures. Excellent communication, interpersonal, and customer service skills. Proficiency in using healthcare software systems and claims processing platforms. Ability to work independently and as part of a team. Attention to detail and ability to manage multiple tasks. Familiarity with medical terminology.