Hospital Compliance Specialist

4 days ago

Delhi, Delhi, India beBeeRegulatory Full time ₹ 17,70,000 - ₹ 21,90,000
Compliance and Empanelment Expert

The key to our organization's success lies in our ability to drive empanelments with TPAs, insurance providers, and government health schemes while ensuring hospital operations comply with regulatory frameworks.

This role plays a pivotal part in achieving this goal, requiring a deep understanding of statutory and regulatory requirements as well as excellent negotiation skills.

  • Develop and implement strategies for maintaining hospital licenses and certifications.
  • Coordinate with legal advisors and regulatory authorities to ensure timely renewals of mandatory approvals and registrations.
Empanelments and Insurance Management:
  • Lead the process of obtaining and maintaining empanelments with major TPA providers.
  • Oversee the documentation and application submission process for empanelments and rate contracts.
Recovery and Claims Management:
  • Monitor payment cycles and work with TPAs and insurers to ensure timely settlement of claims.
  • Investigate and resolve claim discrepancies and denials, ensuring maximum recovery.
Requirements:
  • LL.B degree is preferred but not mandatory; Bachelors degree required.
  • A minimum of 5 years of experience in hospital compliance or liaison roles.
  • Prior experience in multispecialty hospitals or TPA/insurance companies is highly desirable.

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