MantraCare - Manager - TPA & Empanelment

23 hours ago

New Delhi, India MantraCare Full time

Title: Manager TPA & EmpanelmentLocation: Eye Mantra Hospital - Paschim ViharDepartment: AdministrationJob Mantra Hospital is seeking a highly experienced TPA & Empanelment Manager with a strong background in eye/ophthalmology hospitals. The candidate will be responsible for managing insurance operations, ensuring smooth and timely claim processing, handling empanelment with various payers, and building strong partnerships with TPAs and insurance companies. Prior experience in an eye care setup is essential to efficiently manage ophthalmology-specific procedures, packages, coding, and claims.Key Lead and manage TPA operations specific to ophthalmology services, ensuring accurate documentation and claim processing for eye procedures.- Drive empanelment with insurance companies, corporates, and government health schemes with a focus on ophthalmology packages (cataract, LASIK, retina, glaucoma, etc.).- Oversee contract renewals, tariff negotiations, package updates, and ensure compliance with eye-carespecific empanelment terms.- Build and maintain strong relationships with TPAs, insurance partners, corporate clients, and government health bodies.- Prepare insurance-related MIS, package performance reports, and revenue insights for senior management.- Handle escalations related to patients, insurance claims, approvals, pre-authorizations, and TPA processes.- Coordinate with ophthalmology consultants, billing teams, and patient coordinators to ensure smooth insurance workflows.- Stay updated with the latest insurance guidelines, Ayushman Bharat schemes, and policies relevant to eye care.Qualifications & Experience:- Bachelors or Masters degree in Healthcare Administration / Business Management or related fields.-3+ years of experience in TPA operations or hospital empanelment specifically in an eye hospital or ophthalmology center (minimum 2 years in a managerial role).- Strong understanding of ophthalmic procedures, coding, insurance packages, and claim documentation.- Experience using hospital management software and insurance portals.- Excellent communication, negotiation, and analytical skills.Key Skills:- Leadership & Team Management- Ophthalmology Insurance & TPA Knowledge- Empanelment & Contract Negotiation- Relationship & Stakeholder Management- Compliance & Regulatory Knowledge- Problem Solving & Conflict Resolution- Eye-carespecific billing & documentation expertise (ref:iimjobs.com)

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