Tpa Coordinator

**Key Responsibilities**:
**1. Insurance Coordination & Approvals**
- Liaise with **TPAs and insurance companies** for pre-authorization and claim processing.
- Ensure timely **cashless approvals** for inpatient admissions and procedures.
- Regularly follow up on **pending approvals, claim rejections, and reimbursements**.
- Provide **insurance eligibility verification** for patients before admission.

**2. Patient Support & Documentation**
- Assist patients and families in understanding **insurance coverage, required documentation, and claim submission procedures**.
- Ensure proper collection and verification of documents like **policy papers, ID proofs, discharge summaries, and medical records**.
- Guide patients through the **grievance redressal process** in case of disputes with TPAs.

**3. Claim Processing & Billing Coordination**
- Work closely with the **billing and finance teams** to ensure correct coding and claim submissions.
- Track **pending, denied, or under-process claims** and escalate when needed.
- Maintain a **real-time database of claim status** and generate periodic reports.

**4. Compliance & Regulatory Adherence**
- Ensure all claims follow **IRDAI guidelines, hospital policies, and government health schemes.**
- Stay updated with the latest insurance policies, pre-authorization procedures, and regulatory changes.
- Maintain documentation for **insurance audits and internal compliance checks**.

**5. Internal & External Coordination**
- Coordinate with **doctors, nursing staff, and medical records** teams to streamline the insurance process.
- Manage hospital empanelment with TPAs and **negotiate agreements as needed**.
- Use **hospital management software (HMS) and TPA portals** for seamless claim processing.

**6. Special Focus on Neurological Care**
- Ensure **fast-tracked approvals** for critical neurology cases (stroke, traumatic brain injury, epilepsy, etc.).
- Understand **high-cost neuro treatments** (MRI, EEG, ICU care, neurosurgeries) and their impact on insurance approvals.
- Work proactively to prevent **insurance delays** in **emergency cases requiring urgent intervention**.

**Requirements**:

- **Education**: Bachelor’s degree in Healthcare Administration, Business, or a related field.
- **Experience**: 1-3 years in TPA coordination, hospital administration, or health insurance processing.
- **Skills**:
✔ Strong knowledge of **insurance claim procedures & TPA guidelines**.

✔ Familiarity with **ICD-10 codes, CPT coding, and medical billing**.

✔ Proficiency in **hospital management systems (HMS), MS Office, and TPA portals**.

✔ Strong **communication, negotiation, and problem-solving** skills.

**Preferred Qualifications**:

- Prior experience in **a neurology or multispecialty hospital**.
- Knowledge of **government insurance schemes and corporate empanelment**.
- Ability to **handle high-pressure situations and multitask efficiently**.

**Why Join Namah Neuro Hospital?**

✔ **Work in a leading neurology-focused healthcare institution**.

✔ **Contribute to critical patient care by ensuring smooth insurance approvals**.

✔ **Be part of a dynamic and patient-first healthcare team**.

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

Pay: ₹15,000.00 - ₹25,000.00 per month

**Benefits**:

- Paid time off

Schedule:

- Day shift

Supplemental Pay:

- Yearly bonus

Work Location: In person

Expected Start Date: 10/03/2025