Billing / Insurance / Tpa Execuive
18 hours ago
**Job Summary**:
The TPA Executive is responsible for handling all Third Party Administrator-related activities in the hospital including insurance claim processing, documentation, coordination with insurance companies, and ensuring timely approvals and settlements.
**Key Responsibilities**:
- **Patient Admission**:
- Verify patient insurance details at the time of admission.
- Facilitate cashless admission by coordinating with TPA/insurance companies.
- Maintain proper documentation for pre-authorization.
- **Documentation and Claim Processing**:
- Prepare and submit pre-authorization and final claim documents to TPAs/Insurance Companies.
- Ensure timely submission of all relevant medical documents and bills.
- Follow up on pending claims and approvals.
- **Coordination**:
- Communicate with consultants/doctors for medical inputs required for pre-authorizations and claim processing.
- Act as a liaison between the hospital and insurance/TPA representatives.
- **Discharge and Final Billing**:
- Ensure timely discharge approvals from TPA/Insurance.
- Coordinate for final settlement of cashless claims.
- Inform patient/family in case of any shortfall or rejection in claim amount.
- **MIS and Reporting**:
- Maintain and update TPA MIS (claim status, approvals, rejections, payments).
- Report discrepancies, delays, or issues to management for timely action.
- **Compliance**:
- Ensure compliance with IRDAI norms and hospital policies.
- Maintain confidentiality of patient and financial information.
**Qualifications**:
- Graduate in any stream (preferably commerce or healthcare).
- Minimum 1-5 years of experience in TPA/Insurance desk in a hospital.
**Job Types**: Full-time, Permanent
Pay: ₹30,000.00 - ₹40,000.00 per month
**Benefits**:
- Health insurance
- Provident Fund
Work Location: In person
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