Tpa Executive

4 days ago

Delhi Delhi, India Mantra Care Full time

**Job Title: TPA Executive**

**Job Location**: Eye Mantra Hospital, Pachim VIhar, Delhi
**Reports To**: TPA Manager / Billing and Insurance Manager

**Key Responsibilities**:

- **Insurance Verification and Authorization**:

- Verify patient insurance details and eligibility at the time of admission or prior to medical procedures.
- Liaise with the respective TPAs and insurance providers to obtain pre-authorization and pre-certification for medical services.
- Ensure that all necessary documentation, including patient medical records and treatment plans, are provided for pre-authorization and claims processing.
- **Claims Management**:

- Process and follow up on insurance claims, ensuring that claims are submitted accurately and in a timely manner.
- Coordinate with the insurance companies and TPAs for claim settlement, follow-up, and reimbursement.
- Resolve any discrepancies or issues related to claims, including incomplete documentation or disputes.
- **Documentation and Record Keeping**:

- Maintain accurate and up-to-date records of insurance policies, claim submissions, authorizations, and rejections.
- Ensure that all patient insurance-related documents are organized and readily accessible for audits and reviews.
- **Patient Interaction and Assistance**:

- Communicate with patients to inform them about insurance coverage and the documentation required for TPA processing.
- Assist patients in understanding their insurance policies, benefits, and any out-of-pocket expenses that they may incur.
- Act as a point of contact for patients to resolve any concerns or queries related to TPA or insurance claims.

**Skills and Qualifications**:

- **Experience**:

- Minimum 1-3 years of experience in handling TPA or insurance-related activities in a healthcare setting, preferably in an ophthalmology or multi-specialty hospital.
- Prior experience in medical billing, insurance verification, and claim management is a plus.
- **Education**:

- Bachelor's degree in any stream (preferably healthcare administration, insurance, or medical billing).
- Certification or training in medical billing or healthcare management is a plus.
- **Skills**:

- Knowledge of insurance processes, claim submissions, and pre-authorization procedures.
- Familiarity with TPA systems, healthcare billing software, and insurance-related documentation.
- Strong organizational and time-management skills.
- Excellent communication skills (both written and verbal) to interact with insurance providers, patients, and hospital departments.
- Attention to detail and ability to handle sensitive information in a confidential manner.
- Ability to handle multiple tasks and manage deadlines effectively.

Pay: ₹15,000.00 - ₹25,000.00 per month

Schedule:

- Day shift

**Experience**:

- total work: 1 year (preferred)

Work Location: In person

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