Tpa Coordinator

10 hours ago

Ghansoli Navi Mumbai Maharashtra, India Stemrx Hospital and Research centre Full time

**Job Description: TPA and Billing Executive**

**Location**: StemRx Hospital and Research Centre, Rabale

**Salary**: ₹25,000 per month

**Position Overview**:
The TPA and Billing Executive will be responsible for managing the empanelment of insurance and TPA (Third Party Administrator) processes, as well as handling IPD (In-Patient Department) patient billing. This role is crucial to ensuring smooth coordination between the hospital, insurance companies, TPAs, and patients, while also maintaining accurate and timely billing operations.

**Key Responsibilities**:
1. **TPA and Insurance Empanelment**:

- Coordinate with various insurance companies and TPAs for empanelment processes.
- Maintain and update the database of empaneled TPAs and insurance providers.
- Ensure all required documentation and agreements are in place for each empanelment.

2. **IPD Billing Management**:

- Prepare and manage billing for IPD patients, ensuring accuracy and compliance with hospital policies.
- Verify insurance and TPA details for each patient and ensure proper documentation is maintained.
- Coordinate with the accounts department to ensure timely submission of bills and claims to TPAs and insurance companies.

3. **Claims Management**:

- Process and submit insurance claims, ensuring all necessary documentation is provided.
- Follow up on pending claims with TPAs and insurance companies to ensure timely settlement.
- Address any discrepancies or rejections in claims and take corrective action as required.

4. **Patient Interaction**:

- Assist patients and their families with understanding the billing process, insurance coverage, and claim status.
- Handle patient queries related to billing and insurance claims, providing timely and accurate information.

5. **Reporting and Documentation**:

- Maintain records of all billing transactions, insurance claims, and empanelment documentation.
- Prepare regular reports on billing and claim status for management review.
- Ensure compliance with hospital policies, insurance regulations, and government guidelines.

6. **Coordination and Collaboration**:

- Work closely with the hospital's finance, administration, and clinical teams to ensure seamless operations.
- Liaise with insurance companies and TPAs for any issues related to empanelment, billing, or claims.

**Qualifications and Skills**:

- Bachelor’s degree in Commerce, Business Administration, or a related field.
- 2+ years of experience in hospital billing and TPA management.
- Strong knowledge of insurance processes, TPA operations, and healthcare billing practices.
- Excellent communication and interpersonal skills.
- Proficient in using hospital management software and billing systems.
- Attention to detail and ability to work under pressure.

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

**Benefits**:

- Paid sick time

Schedule:

- Day shift
- Weekend availability

Supplemental Pay:

- Performance bonus

**Experience**:

- total work: 2 years (preferred)

Work Location: In person

Expected Start Date: 02/09/2024

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