TPA Executive

Pre-authorization and Insurance Information services:

Perform a variety of clerical duties involved in the preparation and processing of insurance forms to initiate patient claims, collect carrier liability.

Other duties include the pre-authorization, pre-certification of surgery/ treatment/ procedures, patient statements, billing enquiries.

Knowledge of all billing guidelines, including Mediclaim, Health Insurance and Commercial insurance.

Assist in the maintenance of patient insurance files and preparation of routine statistical reports.

Take information from consultants, fellows and residents about the patient for documentation requirements

Interact with internal contacts such as Manager-Front Desk & OPD for company patients appointment and consultation, Manager- Surgical Coordination for surgery appointments of client patients, Manager-Speciality Clinics for scheduling and coordination of client patients speciality diagnosis and treatments.

Provide information and answer inquiries concerning insurance and billing procedures; receive and reply to claims correspondence; notify patient of liability status.

Billing, Documentation and Claim processing services:

Compose memos, correspondence, and forms. Review outgoing material for completeness, accuracy, dates and signature. Assemble attachments.

Evaluate report documentation, coding processes and format processes according to the client and third party reimbursement for the department.

Perform quality control procedures adhering to the set checklist for pre-billed reports and documents. Review for missing documentation and follow-up with the consultants, fellows, residents or optometrists. Initiate and follow through with corrective action.

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Review billing, payment, and denial information utilizing a e-claims online system and hospital information system. Identify potential reasons for payment denial. Initiate and follow through with appropriate remedial actions.

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Electronic claims submission, billing insurance/patients for services, client billing, general clerical duties.

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Reject processing and Re-submission services:

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Responsible for the generation of electronic and paper claims, along with the knowledge of making corrections for resubmission.

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Work in concert with third party billing agency to resolve rejected claims, especially due to medical necessity and pre-certification issues.

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Accounts, Book keeping and Credit information services:

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Perform a variety of clerical accounting tasks to properly settle patient accounts receivable in accordance with general credit policy; review accounts to ascertain such data as previous action taken, status and extent of insurance coverage and payments received; determine and implement appropriate collection or refund action.

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Serve as a backup for the accounts departments credentialing coordinator.

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Manage and coordinate activities concerning credit patient billing, accounts receivable, collections, third-party claims and related accounting and bookkeeping operations of the credit billing and collection.

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Prepare reports and analyses, including financial statements, setting forth progress, adverse trends and appropriate recommendations or conclusions.

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Provide information concerning patient accounts to authorized personnel; answer inquiries concerning credit and collection matters.

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To co-ordinate with Manager Accounts for credit information and refund of excess money or any other valid refunds for the patients if any.

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Create working spreadsheets and maintain computerized databases. Record and report results of billing and payment data review. Create and maintain office-filing systems.

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Responsibilities include charge and payment posting using Client Tariff on HIS.

Credit Services:

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Recognize potential credit problems and keep current of patient balances, along with collections experience

Resolve ongoing problems in billing and reimbursement. Process remedial actions and provide pre-billing quality controls.

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Investigate and resolve non-routine billing problems with patients, third party payers and government clients.

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Incase of unresolved problems inform General Manager- BD & Admin to do the needful.

Job Types: Full-time, Permanent

Pay: ₹18,000.00 - ₹20,000.00 per month

Benefits:

• Health insurance
• Leave encashment
• Life insurance
• Provident Fund

Experience:

• total work: 1 year (Preferred)

Work Location: In person