[Urgent] Need a TPA person for eye care hospital gurgaon sector 49

2 days ago

Gurugram Gurugram India Medico Hub Full time

Job Description Contact Mr Nishant Chaudhary WhatsApp 91050 24073 Industry & Sector: Private healthcare Ophthalmology / Eye Care hospital operating in Gurgaon (Sector 49). We provide clinical and surgical eye-care services, outpatient and inpatient workflows, and manage insured patient volumes through hospital-TPA partnerships. Primary Job Title: TPA Coordinator (Medical Insurance & Cashless Claims) Role & Responsibilities - Manage end-to-end TPA interactions for insured patients: verify policy details, initiate pre-authorizations, and follow up for cashless approvals. - Process IP and OP claims accurately: prepare and submit supporting documents, code procedures/diagnoses per hospital guidelines, and track claim lifecycle to resolution. - Coordinate with clinical teams, billing, and OP/IP counters to ensure timely documentation and reduce claim rejections or delays. - Resolve denials and escalations with TPAs: perform root-cause analysis, submit appeals or clarifications, and close pending claims within SLA. - Maintain daily logs and dashboards for claims status, authorizations, reimbursements, and aging; escalate trends to department lead. - Ensure compliance with insurer policies, hospital SOPs, and patient confidentiality requirements while supporting audit requests. Skills & Qualifications Must-Have - Proven experience handling TPA processes and cashless authorizations in a hospital setting. - Strong knowledge of medical insurance claim documentation and common rejection reasons. - Hands-on experience with Hospital Information Systems (HIS) or EMR platforms for claims and billing. - Advanced MS Excel skills for reconciliation, reporting, and claims tracking. - Attention to detail, ability to manage multiple insurer portals, and follow insurer SLAs precisely. - Fluent in English and Hindi; comfortable communicating with TPAs, patients, and clinical staff on-site. Preferred - Prior exposure to ophthalmology procedures, package pricing, and surgery authorization workflows. - Experience with denial management and claim appeal preparation for large TPAs. - Familiarity with local insurer networks and policy nuances for Gurgaon/Haryana region. Benefits & Culture Highlights - On-site role with direct patient interaction in a focused eye-care environment strong opportunity to build domain expertise. - Collaborative clinical and admin teams, with mentorship for process improvement and career progression. - Competitive hospital-staff benefits and opportunities for training on HIS/claims tools. Location: Gurgaon, Sector 49 On-site role. Employer: Medico Hub (Eye Care Hospital). Skills: tpa,insurance,teams,appeals,documentation,his,skills,advanced,ophthalmology

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