TPA Executive

Job Description

Job Title: TPA Executive Department: Billing / Insurance / Administration Reports To: TPA Coordinator / Hospital Administrator Key Responsibilities: 1. Patient Admission and Insurance Verification: Collect and verify insurance documents from patients. Coordinate with the insurance provider (TPA – Third Party Administrator) for pre-authorization. Ensure the insurance policy covers the proposed treatment. 2. Pre-authorization Process: Submit pre-authorization requests with accurate patient medical details. Follow up with TPA for approval or queries. Ensure timely approvals to avoid delays in treatment. 3. Billing Coordination: Coordinate with the billing department to prepare interim and final bills. Ensure that charges are correctly entered as per TPA-approved tariffs. Share required billing and medical documents with TPA for processing. 4. Discharge Formalities: Coordinate with TPA for final approval at the time of discharge. Submit final bill and discharge summary for final settlement. Ensure approval is received before patient leaves. 5. Claim Documentation and Submission: Compile and submit complete claim files to TPA within timelines. Maintain accurate records of submitted and approved claims. Track rejected or pending claims and re-submit if needed. 6. Liaison & Coordination: Act as a bridge between hospital, patients, and insurance/TPA companies. Respond to queries raised by TPA or patients. Maintain professional communication with TPA representatives. 7. Reporting and Record Maintenance: Maintain database of cashless and insurance patients. Prepare daily/weekly/monthly reports of claims submitted, approved, and pending. Ensure proper filing and archiving of documents for audit purposes. Skills & Competencies: Good knowledge of health insurance and hospital billing processes. Familiarity with medical terminology and treatment procedures. Proficiency in MS Office and hospital management software (HIS). Strong communication and coordination skills. Attention to detail and time management. Educational Qualification: Graduate in any discipline (preferably commerce or healthcare-related). Additional certification in medical billing or insurance is a plus. Experience: 1–3 years of experience in TPA/insurance processing in a hospital setting preferred. * Job Type: फ़ुल-टाइम Pay: From ₹10,184.94 per month Benefits: पेमेंट वाली छुट्टियाँ प्रॉविडेंट फ़ंड Work Location: In person