Tpa Executive

4 days ago

Sikandar Agra Uttar Pradesh, India UJALA CYGNUS RAINBOW HOSPITAL, AGRA Full time

The TPA Executive in the hospital oversees the management of relationships with Third-Party Administrators (TPAs) to ensure efficient billing, timely reimbursement, and adherence to regulatory standards. They are responsible for optimizing revenue cycle processes, maintaining high levels of customer satisfaction, and driving strategic initiatives to enhance financial performance.

**Responsibilities**:

- **TPA Relationship Management**:

- Serve as the primary point of contact for all TPA-related inquiries, escalations, and negotiations.
- Build and maintain strong relationships with TPAs to facilitate seamless communication and resolution of issues.
- Collaborate with TPAs to streamline billing processes, address payment discrepancies, and ensure timely reimbursement.
- **Revenue Cycle Optimization**:

- Oversee the hospital's revenue cycle operations, including coding, billing, claims processing, and collections.
- Analyze revenue cycle metrics and performance indicators to identify areas for improvement and implement corrective actions.
- Develop strategies to minimize denials, reduce days in accounts receivable, and maximize revenue capture.
- **Compliance and Regulatory Oversight**:

- Ensure compliance with federal, state, and local regulations governing healthcare billing and reimbursement.
- Stay abreast of changes in regulatory requirements and implement necessary updates to billing practices and procedures.
- Conduct regular audits and reviews to monitor compliance with TPA contracts and regulatory standards.
- **Financial Analysis and Reporting**:

- Analyze financial data related to TPA reimbursements, billing trends, and revenue cycle performance.
- Prepare regular reports and presentations for senior management, highlighting key performance indicators and financial metrics.
- Identify opportunities for revenue enhancement and cost containment through data-driven analysis and strategic initiatives.
- **Team Leadership and Development**:

- Supervise and mentor revenue cycle staff, providing guidance, training, and performance feedback.
- Foster a culture of accountability, collaboration, and continuous improvement within the revenue cycle team.
- Lead initiatives to enhance staff productivity, efficiency, and customer service excellence.

**Qualifications**:
Pay: ₹11,000.00 - ₹18,000.00 per month

Schedule:

- Day shift
- Fixed shift
- Rotational shift

**Experience**:

- 3YEARS: 2 years (preferred)

Work Location: In person

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