Tpa Coordinator-hospital Experience

1 week ago

Raipur Chhattisgarh, India Ashoka superspeciality women hospital &Research Pvt.Ltd. Full time

**Pre-Admission & Admission**:

- Collect and verify insurance documents from patients.
- Coordinate with treating doctors for necessary documents (e.g., diagnosis, treatment plan).
- Initiate pre-authorization process with TPA/insurance companies.
- Follow up for approval and ensure timely admission under cashless treatment.

2. **During Hospitalization**:

- Maintain communication with TPAs for interim approvals/extensions as required.
- Ensure all procedures or treatments are approved and documented properly.
- Maintain accurate records of approvals and patient documents.

3. **Discharge Process**:

- Submit final bill and discharge summary to the insurance company/TPA.
- Follow up for final approval and inform the billing department.
- Ensure patient discharge only after approval or necessary payment clearance.

4. **Post-Discharge & Reimbursement**:

- Support patients in submitting reimbursement claims.
- Coordinate with TPA for follow-ups on pending claims.
- Maintain detailed MIS for claim submissions, approvals, rejections, and pending cases.

5. **Documentation & Compliance**:

- Maintain confidentiality and accuracy in all insurance-related documents.
- Ensure compliance with hospital policies.
- Liaise with internal departments for audits and compliance checks.

**Required Skills & Qualifications**:

- Graduate in any discipline (preferably in Healthcare or Insurance).
- 2-5 years of experience in TPA/insurance coordination in a hospital setting.
- Good understanding of health insurance processes and documentation.
- Strong communication and interpersonal skills.
- Proficiency in MS Office and hospital information systems (HIS).
- Ability to handle stress and multitask in a fast-paced environment.

**Preferred**:

- Certification in Hospital Administration or Health Insurance.
- Experience with major TPAs and knowledge of cashless claim platforms.
- **25-30k/month**

Work Location: In person

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