Tpa Coordinator

**Job Title**: TPA Coordinator

**Job Type**: Full-Time

**Location**:REWARI, HARYANA

**Key Responsibilities**:

- **Insurance Verification**:

- Verify patient insurance coverage and eligibility before treatment or admission.
- Ensure all necessary documentation is collected and processed for insurance claims.
- **Claims Management**:

- Submit claims to third-party insurers (TPA companies), ensuring they meet all insurance guidelines.
- Follow up with insurance companies to resolve claim issues and ensure timely payment.
- Monitor and track the status of claims and ensure they are processed correctly.
- **Communication**:

- Serve as a liaison between the hospital, insurance providers, and patients for all matters related to claims and approvals.
- Communicate with patients regarding the status of their insurance claims and resolve any issues or discrepancies.
- Inform the hospital staff about insurance requirements and changes.
- **Documentation & Record Keeping**:

- Maintain accurate and up-to-date records of all insurance claims, approvals, rejections, and payment statuses.
- Ensure proper documentation for insurance purposes, including pre-authorization requests and discharge summaries.
- **Pre-authorization and Approvals**:

- Coordinate with insurance companies for pre-authorization requests for various medical services and procedures.
- Ensure that all approvals are obtained before proceeding with medical treatments or surgeries.
- **Reimbursement & Payment Follow-up**:

- Monitor payments received from insurance companies and patients, ensuring accurate and timely reimbursement.
- Handle any discrepancies between the expected reimbursement and the actual payment.
- **Dispute Resolution**:

- Resolve any issues, disputes, or denials related to insurance claims.
- Liaise with both patients and insurance companies to negotiate and appeal claim rejections.
- **Compliance & Updates**:

- Ensure that all processes comply with hospital policies and legal regulations related to insurance and claims.
- Stay updated with changes in insurance policies, procedures, and government regulations.

**Qualifications**:

- **Education**: Bachelor’s degree in Healthcare Administration, Insurance, or a related field.
- **Experience**: Previous experience in hospital administration, insurance billing, or as a TPA Coordinator is preferred.
- **Skills**:

- Strong understanding of insurance policies, claims, and third-party administration processes.
- Excellent communication and negotiation skills.
- Proficiency in hospital management software and claim processing systems.
- Detail-oriented with strong organizational skills.
- Ability to work under pressure and meet deadlines.
- Knowledge of medical terminology and healthcare services.

**Working Conditions**:

- Office-based, within the hospital’s administration department.
- May require working closely with healthcare providers, insurance companies, and patients.
- Some flexibility in hours, especially when dealing with urgent claims or documentation requirements.

Pay: ₹9,756.60 - ₹40,606.87 per month

**Benefits**:

- Health insurance

Schedule:

- Day shift

Supplemental Pay:

- Overtime pay

Work Location: In person