Tpa Executive

6 hours ago

Shivajinagar Pune Maharashtra, India Sancheti Hospital Full time

Key Responsibilities:

- **TPA Coordination**:

- Liaise with Third Party Administrators (TPA) to manage and process insurance claims for patients admitted to the hospital.
- Coordinate with insurance companies for pre-authorization of treatment and medical procedures.
- Ensure that all required documents for claim submission are complete, accurate, and compliant with insurance policies.
- **Claims Management and Follow-up**:

- Process and monitor insurance claims from the initial submission to settlement.
- Track the progress of claims and follow up with the TPA or insurance companies to ensure timely reimbursement.
- Address claim rejections or disputes and work with the relevant parties to resolve issues.
- **Pre-Authorization and Verification**:

- Verify patient insurance coverage and eligibility with TPA or insurance providers before admission.
- Obtain pre-authorization for specific medical treatments, surgeries, or procedures as per the insurance policy requirements.
- Communicate pre-authorization statuses to patients and hospital staff.
- **Billing and Documentation**:

- Prepare and maintain accurate records of all insurance-related documentation, including claims, pre-authorization, and approvals.
- Ensure all medical procedures, tests, and services are documented correctly for billing purposes.
- Coordinate with the hospital billing department to ensure proper coding and invoicing based on insurance guidelines.
- **Customer Service**:

- Provide assistance to patients by explaining insurance benefits, claims status, and any issues or delays with claim processing.
- Communicate with patients and insurance companies regarding any discrepancies or clarifications needed for claims.
- Ensure the patient experience is smooth and any concerns regarding insurance claims are addressed promptly.
- **Compliance and Regulatory Adherence**:

- Ensure that all insurance claims and processes comply with the hospital's policies, insurance regulations, and industry standards.
- Stay updated on changes in insurance policies, regulations, and procedures that may affect claim processing and reimbursement.
- **Reporting and Documentation**:

- Prepare reports on TPA claim status, outstanding claims, and payment updates for management.
- Keep accurate logs of approvals, denials, and payment statuses for future reference and auditing.

Pay: ₹20,000.00 - ₹25,000.00 per month

Schedule:

- Day shift

**Experience**:

- total work: 3 years (required)

Work Location: In person

Application Deadline: 05/02/2025

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