Tpa Co-ordinator

6 days ago

Gurugram Haryana, India Swastik Hospital, Sector 62 Gurugram Haryana Full time

**TPA Coordinator** acts as a bridge between the **hospital, insurance companies**, and **patients**, handling all matters related to **cashless insurance claims**, **pre-authorizations**, and **reimbursements**. They ensure smooth processing of documents and compliance with TPA policies for both insured patients and the hospital.

**Key Roles & Responsibilities**

**Insurance Processing**
- Facilitate **pre-authorization** for cashless treatments by submitting medical documents to TPAs.
- Track approval status and communicate decisions to patients and billing team.
- Handle **reimbursement cases** by preparing and submitting proper documentation to insurance companies.

**Documentation & Coordination**
- Collect and verify required documents from patients (ID proof, insurance card, policy documents, etc.).
- Coordinate with doctors and departments to get accurate treatment details and discharge summaries.
- Submit final bills and medical records to TPA for settlement.

**Patient Interaction**
- Explain the **insurance claim process** to patients and their families.
- Help patients choose eligible insurance packages or inform them about exclusions.
- Handle patient queries or grievances related to insurance.

**Billing & Claims Follow-Up**
- Work closely with the billing department to prepare and finalize claims.
- Follow up with TPA for **pending or rejected claims**.
- Maintain records of all claims filed, approvals, rejections, and payments received.

**Compliance & Audit**
- Ensure compliance with **IRDAI** (Insurance Regulatory and Development Authority of India) and hospital policies.
- Prepare reports for hospital management or audits as needed.

**Skills Required**:

- Knowledge of medical insurance processes
- Familiarity with hospital billing software (e.g., MediAssist, MedNet, FHPL, HealthIndia)
- Good communication and interpersonal skills
- Attention to detail in documentation
- Ability to handle pressure and coordinate across departments
- Basic medical terminology (useful when handling diagnosis/procedures)

**Qualification**
- **Minimum**: Graduate (any stream, preferably B.Com, BBA, or BA)
- **Preferred**: Diploma or certification in Hospital Administration, TPA, or Medical Billing
- Basic computer and typing skills are essential
- Previous experience in hospital front office or billing is a plus

**Typical Work Environment**
- Hospital Front Office / Insurance Desk

**Job Types**: Full-time, Permanent

Pay: From ₹20,000.00 per month

Work Location: In person

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