Tpa Executive

14 hours ago

Mahmoorganj Varanasi Uttar Pradesh, India The Fracture Clinic & Trauma Hospital Varanasi Health care pvt.ltd. Full time

**Job Title**: TPA Executive

**Department**: Billing / Insurance / Administration
**Reports To**: TPA Coordinator / Hospital Administrator

**Key Responsibilities**:1. **Patient Admission and Insurance Verification**:

- Collect and verify insurance documents from patients.
- Coordinate with the insurance provider (TPA - Third Party Administrator) for pre-authorization.
- Ensure the insurance policy covers the proposed treatment.

2. **Pre-authorization Process**:

- Submit pre-authorization requests with accurate patient medical details.
- Follow up with TPA for approval or queries.
- Ensure timely approvals to avoid delays in treatment.

3. **Billing Coordination**:

- Coordinate with the billing department to prepare interim and final bills.
- Ensure that charges are correctly entered as per TPA-approved tariffs.
- Share required billing and medical documents with TPA for processing.

4. **Discharge Formalities**:

- Coordinate with TPA for final approval at the time of discharge.
- Submit final bill and discharge summary for final settlement.
- Ensure approval is received before patient leaves.

5. **Claim Documentation and Submission**:

- Compile and submit complete claim files to TPA within timelines.
- Maintain accurate records of submitted and approved claims.
- Track rejected or pending claims and re-submit if needed.

6. **Liaison & Coordination**:

- Act as a bridge between hospital, patients, and insurance/TPA companies.
- Respond to queries raised by TPA or patients.
- Maintain professional communication with TPA representatives.

7. **Reporting and Record Maintenance**:

- Maintain database of cashless and insurance patients.
- Prepare daily/weekly/monthly reports of claims submitted, approved, and pending.
- Ensure proper filing and archiving of documents for audit purposes.

**Skills & Competencies**:

- Good knowledge of health insurance and hospital billing processes.
- Familiarity with medical terminology and treatment procedures.
- Proficiency in MS Office and hospital management software (HIS).
- Strong communication and coordination skills.
- Attention to detail and time management.

**Educational Qualification**:

- Graduate in any discipline (preferably commerce or healthcare-related).
- Additional certification in medical billing or insurance is a plus.

**Experience**:

- 1-3 years of experience in TPA/insurance processing in a hospital setting preferred.

*

**Job Type**: फ़ुल-टाइम

Pay: From ₹10,184.94 per month

**Benefits**:

- पेमेंट वाली छुट्टियाँ
- प्रॉविडेंट फ़ंड

Work Location: In person

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