Tpa Executive

3 days ago

Dhanori Pune Maharashtra, India Bapat Multispeciality Hospital Full time

**Department**: Billing / Finance / TPA
**Reports To**: TPA Manager / Billing Head / Hospital Administrator
**Employment Type**: Full-time

**Job Summary**:
The TPA (Third Party Administrator) Executive is responsible for coordinating and managing all aspects related to cashless insurance and TPA billing operations in the hospital. This includes pre-authorization, insurance documentation, claim submissions, and following up with TPAs/insurance companies to ensure timely settlement of claims.

**Key Responsibilities**:

- **Pre-Authorization & Admission Process**:

- Coordinate with the treating doctor to obtain necessary medical information for pre-authorization.
- Submit pre-authorization requests to the respective TPAs/insurance companies.
- Follow up for approval and inform patients/attendants accordingly.
- **Insurance Documentation**:

- Collect and verify insurance documents from patients at the time of admission.
- Ensure all required forms (insurance card, ID proof, policy documents, etc.) are accurately filed.
- **Claim Management**:

- Prepare and submit claims to TPAs/insurance companies with proper documentation.
- Monitor claim status and follow up for pending payments or rejections.
- Handle queries and rejections, resubmit claims as needed.
- **Discharge Process**:

- Coordinate with medical, nursing, and billing teams to prepare final bill.
- Submit final bill to the TPA for final approval before discharge.
- Ensure timely issuance of discharge summary and final bill approval.
- **Coordination & Communication**:

- Maintain effective communication with patients, insurance companies, TPAs, and internal departments.
- Explain insurance policies and billing procedures to patients.
- **Reporting & Documentation**:

- Maintain daily reports of admissions, approvals, discharges, and claim submissions.
- Maintain up-to-date records of insurance companies and TPA contacts.
- Ensure compliance with internal hospital policies and insurance norms.

**Key Skills & Competencies**:

- Knowledge of health insurance policies and TPA processes
- Good communication and interpersonal skills
- Attention to detail and accuracy
- Time management and ability to handle pressure
- Proficiency in MS Office and hospital billing software (HIS)

**Educational Qualifications**:

- Bachelor's degree in any discipline (Commerce, Healthcare Administration preferred)
- Certification or training in medical billing/TPA management is an advantage

**Experience**:

- Minimum 1-3 years of experience in TPA operations or hospital billing
- Experience in working with multiple insurance providers and TPAs

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

Pay: ₹20,000.00 - ₹35,000.00 per month

Work Location: In person

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