Need a TPA person for eye care hospital gurgaon sector 49

2 days ago

Gurgaon, Haryana, India Medico Hub Full time ₹ 2,00,000 - ₹ 6,00,000 per year

Contact Mr Nishant Chaudhary WhatsApp

Industry & Sector: Private healthcare — Ophthalmology / Eye Care hospital operating in Gurgaon (Sector 49). We provide clinical and surgical eye-care services, outpatient and inpatient workflows, and manage insured patient volumes through hospital-TPA partnerships.
Primary Job Title: TPA Coordinator (Medical Insurance & Cashless Claims)

Role & Responsibilities
  • Manage end-to-end TPA interactions for insured patients: verify policy details, initiate pre-authorizations, and follow up for cashless approvals.
  • Process IP and OP claims accurately: prepare and submit supporting documents, code procedures/diagnoses per hospital guidelines, and track claim lifecycle to resolution.
  • Coordinate with clinical teams, billing, and OP/IP counters to ensure timely documentation and reduce claim rejections or delays.
  • Resolve denials and escalations with TPAs: perform root-cause analysis, submit appeals or clarifications, and close pending claims within SLA.
  • Maintain daily logs and dashboards for claims status, authorizations, reimbursements, and aging; escalate trends to department lead.
  • Ensure compliance with insurer policies, hospital SOPs, and patient confidentiality requirements while supporting audit requests.
Skills & Qualifications
Must-Have
  • Proven experience handling TPA processes and cashless authorizations in a hospital setting.
  • Strong knowledge of medical insurance claim documentation and common rejection reasons.
  • Hands-on experience with Hospital Information Systems (HIS) or EMR platforms for claims and billing.
  • Advanced MS Excel skills for reconciliation, reporting, and claims tracking.
  • Attention to detail, ability to manage multiple insurer portals, and follow insurer SLAs precisely.
  • Fluent in English and Hindi; comfortable communicating with TPAs, patients, and clinical staff on-site.
Preferred
  • Prior exposure to ophthalmology procedures, package pricing, and surgery authorization workflows.
  • Experience with denial management and claim appeal preparation for large TPAs.
  • Familiarity with local insurer networks and policy nuances for Gurgaon/Haryana region.
Benefits & Culture Highlights
  • On-site role with direct patient interaction in a focused eye-care environment — strong opportunity to build domain expertise.
  • Collaborative clinical and admin teams, with mentorship for process improvement and career progression.
  • Competitive hospital-staff benefits and opportunities for training on HIS/claims tools.

Location: Gurgaon, Sector 49 — On-site role.
Employer: Medico Hub (Eye Care Hospital).

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