Head TPA Insurance Operations

16 hours ago

Ahmedabad, India Sterling Addlife Full time

Head TPA

Key Responsibility :

Insurance Empanelment & Relationship Building :

  • Identify and target key insurance providers for empanelment to expand the hospital's network.

  • Lead the process of empanelment, including application, documentation, and site visits.

  • Develop and maintain strong, collaborative relationships with key personnel at TPA and insurance companies.

  • Act as the primary point of contact for all insurance-related matters.

  • Proactively address any issues or concerns raised by TPAs or insurance providers.

Price Negotiation with Insurance Companies:

  • Lead negotiations with insurance companies and TPAs to secure favorable pricing agreements for hospital services.

  • Conduct thorough analysis of costing and market rates to support negotiation strategies.

  • Ensure that negotiated rates are accurately implemented in the hospital's billing system.

  • Regularly review and renegotiate contracts to optimize revenue.

Insurance Collection & Recoveries:

  • Oversee the insurance billing and collection process to ensure timely submission of claims.

  • Implement strategies to minimize claim rejections and maximize recovery rates.

  • Monitor outstanding insurance receivables and proactively follow up for timely payments.

  • Analyze rejection trends and implement corrective actions to improve claim accuracy.

  • Ensure adherence to all relevant insurance regulations and guidelines.

Revenue Cycle Management (Insurance Aspect):

  • Collaborate with other departments (e.g., billing, finance, medical records) to optimize the end-to-end revenue cycle related to insurance payers.

  • Identify and implement process improvements to enhance efficiency and reduce revenue leakage.

  • Stay updated on changes in insurance policies, regulations, and industry best practices.

  • Provide regular reports on insurance empanelment status, collection performance, and key performance indicators.

Qualifications & Experience:

  • Educational qualifications, e.g., bachelor's degree in business administration, Healthcare Management, or a related field.

  • 10+ Years of expertise, preferably in a hospital setting managing TPA and insurance relations.

  • Strong leadership ability of the relationship building

  • Business Acumen

  • Negotiation Skills

  • Proven track record of successful insurance empanelment, price negotiation, and collection recovery.

  • Strong understanding of healthcare insurance processes, regulations, and billing practices.

  • Excellent negotiation, communication, and interpersonal skills.

  • Strong analytical and problem-solving abilities.

  • Proficiency in relevant software and MS Office Suite.

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