
Healthcare Insurance Manager
1 week ago
The Head TPA is responsible for managing the hospital's relationships with third-party administrators (TPAs) and insurance companies. This role involves strategic planning, negotiation, and collaboration to optimize revenue and improve patient care.
Key Responsibilities:
- Identify key insurance providers for empanelment to expand the hospital's network.
- Lead the process of empanelment, including application, documentation, and site visits.
- Maintain strong relationships with key personnel at TPAs 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.
Pricing Strategy and Collection Management
- Negotiate favorable pricing agreements with insurance companies and TPAs.
- Analyze costing and market rates to support negotiation strategies.
- Implement negotiated rates in the hospital's billing system.
- Regularly review and renegotiate contracts to optimize revenue.
- Oversee the insurance billing and collection process.
- Minimize claim rejections and maximize recovery rates.
Qualifications & Experience:
- 10+ Years of expertise, preferably in a hospital setting managing TPA and insurance relations.
- Strong leadership ability, business acumen, negotiation skills, and excellent communication skills.
- Proven track record of successful insurance empanelment, price negotiation, and collection recovery.
- Strong understanding of healthcare insurance processes, regulations, and billing practices.
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