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Hospital Tpa Coordinator

1 month ago

Nashik Maharashtra, India Nimai Institute of Medical Sciences Pvt Ltd Full time

**Key Responsibilities**:

- **Insurance Claims Processing**:

- Coordinate with TPAs and insurance companies for claim approvals, pre-authorizations, and other related processes.
- Submit accurate and timely claims to the insurance companies/TPA.
- Follow up on pending claims, rejections, and discrepancies to ensure claims are processed within stipulated timelines.
- **Cashless Treatment Processing**:

- Assist patients in availing cashless treatments by coordinating between the hospital, patient, and insurance company.
- Ensure that all required documents for cashless hospitalization are accurately filled and submitted on time.
- **Pre-Authorization Approvals**:

- Handle pre-authorization requests from insurance companies for both inpatient and outpatient treatments.
- Track the status of approval and communicate with doctors and patients regarding the approvals or rejections.
- **Documentation & Records Management**:

- Maintain all necessary records of the patient’s insurance details, policy, and claim status.
- Ensure that all claims are filed with complete documentation, including doctor’s reports, treatment plans, invoices, and other supporting documents.
- **Patient Interaction**:

- Provide clear and concise information to patients regarding their insurance coverage, claims process, and any additional steps required.
- Resolve patient queries related to the insurance process and act as a liaison between the patient and insurance provider.
- **Coordination with Hospital Departments**:

- Coordinate with medical, billing, and administrative departments to ensure timely collection of medical reports and bills for submission to TPAs.
- Communicate with doctors and nursing staff regarding medical updates for processing claims and authorizations.
- **Discharge Process Assistance**:

- Ensure the patient’s discharge process is smooth by obtaining final settlement approval from the insurance company or TPA.
- Assist in any additional paperwork required for claim settlement.
- **Claim Reconciliation**:

- Reconcile payments received from TPAs or insurance companies and track the balance amount for each patient’s treatment.
- Resolve any discrepancies between claimed and approved amounts with TPA representatives.
- **Compliance & Regulations**:

- Stay updated with insurance and healthcare policies and ensure compliance with TPA guidelines.
- Ensure that all claims and processes meet regulatory standards set by the insurance companies and government.
- **Reporting**:

- Prepare and maintain regular reports on claims processed, pending approvals, claim settlements, and other relevant data for management review.

**Skills and Qualifications**:

- **Educational Requirements**: Bachelor’s degree in healthcare management, insurance, or a related field.
- **Experience**: 1-3 years of experience in handling insurance or claims processing, preferably in a hospital environment.
- **Technical Skills**: Familiarity with billing software, hospital information systems (HIS), and TPA portals.
- **Interpersonal Skills**: Strong communication and coordination skills to manage relationships with patients, insurance providers, and hospital departments.
- **Problem-Solving**: Ability to handle claims disputes and resolve patient insurance queries efficiently.
- **Attention to Detail**: Accuracy in document handling and claim processing is crucial to avoid rejections and discrepancies.

**Job Types**: Full-time, Permanent

Pay: ₹20,000.00 - ₹30,000.00 per month

**Benefits**:

- Cell phone reimbursement
- Leave encashment
- Provident Fund

Schedule:

- Day shift
- Morning shift

**Experience**:

- total work Hospital TPA Coordinator: 1 year (required)

Work Location: In person