[High Salary] Tpa Medical Officer

1 day ago

Darbhanga BR IN Swami vivekananda cancer hospital, darbhanga Full time

Key Responsibilities 1 Pre-authorization Claim Management Review and validate pre-authorization requests as per medical necessity and insurance policy guidelines Prepare and submit pre-authorization forms with accurate diagnosis procedure codes and estimated costs Monitor approval status and follow up with TPAs for timely authorization Scrutinize final bills discharge summaries and investigation reports before claim submission 2 Coordination Communication Coordinate with consultants nursing staff and billing teams for complete documentation Communicate with TPA coordinators and insurance executives for approvals queries or discrepancies Handle patient or attendant queries related to insurance coverage and approvals 3 Documentation Compliance Ensure all treatment notes prescriptions and reports are attached to claims Maintain accurate and complete records of all TPA-related activities Verify compliance with IRDA and hospital policies regarding TPA operations 4 Medical Review Evaluate the medical justification of treatment plans and hospital stay Cross-check diagnosis and procedure coding ICD CPT to avoid rejections Assist in preparing medical justifications for claim rejections or queries 5 Reporting Prepare daily weekly monthly MIS reports on TPA cases pending approvals and claim settlements Track and analyze TPA claim rejection trends to improve documentation accuracy Skills Competencies Strong medical assessment and analytical skills Good communication and coordination abilities Knowledge of insurance policies and hospital billing systems Attention to detail and documentation accuracy Proficiency in MS Office and HIS Hospital Information System Qualifications Experience Education MBBS BAMS BHMS MBBS preferred Experience Minimum 1-3 years in hospital TPA department insurance claim processing utilization review Knowledge Medical coding ICD CPT TPA software systems and hospital billing Insurance claim workflow and pre-authorization process Job Types Full-time Permanent Pay 30 597 71 - 45 512 63 per month Benefits Cell phone reimbursement Leave encashment Paid sick time Paid time off Provident Fund Education Bachelor s Preferred Experience TPA 2 years Preferred Work Location In person

  • Tpa Medical Officer

    4 days ago

    Darbhanga, India Swami vivekananda cancer hospital, darbhanga Full time

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