Tpa Executive

3 days ago

Maharani Bagh Delhi Delhi, India Rama Advance Care Pvt. Ltd. Full time

**Position**: TPA Executive
**Location**: Sunrise Hospital, Kalindi Colony
**Department**: Billing & Insurance
**Reporting To**: Billing/TPA Manager or Hospital Administrator

**Job Objective**:
To ensure smooth coordination and processing of TPA (Third Party Administrator) and insurance-related documentation for patient admissions, approvals, and discharges, ensuring proper billing and timely reimbursements.

**Key Responsibilities**:

- **TPA & Insurance Coordination**:

- Handle pre-authorization requests and approvals from insurance companies and TPAs.
- Coordinate with patients, doctors, and TPA representatives for required documentation.
- Maintain accurate and updated records for all TPA/insurance patients.
- **Billing Support**:

- Ensure timely submission of medical bills to insurance companies.
- Cross-check the bills and ensure they comply with insurance norms and packages.
- Reconcile claims with approvals and ensure mínimal deductions or rejections.
- **Admission & Discharge Support**:

- Facilitate the admission and discharge processes for TPA/insured patients.
- Prepare final bills in coordination with billing and medical departments.
- Ensure timely communication with TPA coordinators for discharge approvals.
- **Documentation & Follow-up**:

- Maintain complete files with all supporting documents like ID, policy copy, pre-auth forms, discharge summary, etc.
- Track pending claims and follow up for timely settlements.
- Coordinate with internal departments to resolve billing queries or discrepancies.
- **Customer Support**:

- Address patient queries related to TPA/insurance processing.
- Provide assistance in filling forms and understanding policies.
- **Reporting**:

- Generate daily/monthly reports on TPA/insurance billing and settlement status.
- Escalate unresolved or high-pending cases to management.

**Key Skills Required**:

- Knowledge of insurance procedures, TPA coordination
- Good communication and interpersonal skills
- Proficiency in MS Office & Hospital Information Systems (HIS)
- Attention to detail and documentation
- Time management and ability to work under pressure

**Qualification & Experience**:

- Graduate in any stream (Commerce/Healthcare preferred)
- Minimum 1-3 years of experience in hospital TPA/insurance desk

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

Pay: ₹15,000.00 - ₹35,000.00 per month

**Benefits**:

- Cell phone reimbursement
- Paid sick time
- Provident Fund

Schedule:

- Rotational shift

Supplemental Pay:

- Commission pay
- Performance bonus
- Yearly bonus

Work Location: In person

Application Deadline: 16/06/2025

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