Tpa Manager

Job Responsibilities of a TPA Coordinator (Hospital Billing Department)

1. Patient Admission & Pre-Authorization

• Verify patient insurance/TPA details at the time of admission.
  
• Collect required documents and submit

  cashless pre-authorization requests

  to the respective TPA.
• Communicate approvals, denials, or queries from TPA to patients and concerned departments.
  
• Ensure timely follow-up on pending pre-auth approvals.
  

2. Coordination With TPA / Insurance Companies

• Act as the primary point of contact between the hospital and TPAs/insurance companies.
  
• Respond promptly to TPA queries related to patient treatments, packages, line of treatment, etc.
  
• Maintain healthy working relationships with TPA representatives.
  

3. Billing & Documentation

• Ensure all medical records, treatment notes, investigation reports, and bills are accurate and complete.
  
• Prepare final bills for insured patients as per TPA tariff and agreements.
  
• Check admissibility of charges based on TPA policies and guidelines.
  

4. Cashless & Reimbursement Processing

• Process

  cashless discharge approvals

  by sending final bill and discharge summary to TPA.
• Assist patients in documentation for reimbursement claims.
  
• Ensure all claim forms are correctly filled, signed, and stamped.
  

5. Discharge Coordination

• Coordinate with doctors, nurses, and billing team to prepare discharge summary and documentation.
  
• Follow up with TPA for

  final authorization

  to avoid discharge delays.
• Communicate approved and non-approved items to patients clearly.
  

6. Claim Submission & Follow-Up

• Submit completed claims to TPA within timelines.
  
• Track and follow up on claim status to avoid rejections and delays.
  
• Re-submit additional documents or justifications requested by TPA.
  

7. Denial & Query Management

• Handle claim rejections, short-settlements, and TPA queries professionally.
  
• Coordinate with medical team to provide clarifications or additional documents.
  
• Maintain records of denials and initiate corrective actions.

Contact person : Human Resources

Contact Number : 9930400992

Email Address : najma.shaikh@criticareasiahospital.com