Billing / Insurance / Tpa Execuive

3 days ago

Kannamwar Nagar Mumbai Maharashtra, India Adi Arogyam Super Speciality Hospital Full time

**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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