Tpa Coordinator

1. Claim Processing and Management:

- **Accurate and timely claim submission**:Ensuring all required documentation is complete and submitted to the insurance company or TPA within the specified timeframe.
- **Claim verification and review**:Checking claim details, verifying patient insurance coverage, and identifying any discrepancies or denials.
- **Follow-up and resolution**:Contacting the TPA or insurance company to address any issues, such as denied claims, and ensuring they are resolved.
- **Maintaining accurate records**:Keeping detailed records of all claims, including documentation, communication, and claim status.

2. Cashless Claim Management:

- **Verification of TPA cards and policies**:Checking the patient's TPA card, photo ID, and insurance policy to ensure coverage.
- **Pre-authorization and consent**:Assisting patients with filling out necessary forms and obtaining pre-authorization from the TPA.
- **Communication with TPA**:Contacting the TPA to request cashless approval and obtaining necessary documents.
- **Patient support and guidance**:Explaining the cashless process to patients and providing guidance on the documentation required.

3. Liaison and Communication:

- **Hospital-TPA liaison**:Serving as a bridge between the hospital and the TPA to facilitate smooth communication and resolution of issues.
- **Patient communication**:Providing clear and concise information to patients regarding their insurance claims, eligibility, and status.
- **Collaboration with other departments**:Working with billing, finance, and medical staff to ensure accurate and efficient claim processing.

4. Data Management and Reporting:

- **Maintaining patient records**: Keeping patient records updated with insurance information, claim status, and relevant details.
- **Generating reports**: Creating reports on claim processing, reimbursement rates, and other relevant data.
- **Staying updated**: Keeping abreast of changes in insurance policies and regulations.

5. Other Responsibilities:

- **Resolving billing issues**:Discussing discounts with third-party payers and settling claims.
- **Providing financial counseling**:Explaining financial aspects of treatment, including costs and insurance coverage.
- **Ensuring compliance**:Adhering to regulatory requirements and internal processes for claim processing.
- **Providing customer support**:Offering assistance to patients and their families regarding their insurance claims.

In essence, a TPA coordinator plays a crucial role in ensuring smooth and efficient insurance claim processing, providing support to patients, and facilitating seamless communication between the hospital, patients, and insurance providers.

Pay: ₹12,000.00 - ₹18,000.00 per month

**Benefits**:

- Cell phone reimbursement
- Health insurance
- Provident Fund

Schedule:

- Day shift
- Morning shift
- Night shift
- Rotational shift

Work Location: In person