Tpa Billing Executive/ Admissions
2 days ago
Position Summary:
The Admission & TPA Billing Executive is responsible for managing patient admission billing, coordinating with the TPA (Third Party Administrator) for cashless claims, ensuring accurate and timely billing, and maintaining transparency in financial transactions related to inpatient and insurance patients.
Key Responsibilities:
Admission Billing Counter Duties:
- Handle patient admissions and generate admission slips in the hospital system.
- Verify patient details and collect necessary documents (ID proof, referral letter, etc.).
- Explain admission deposit policy, room tariffs, and package details to patients and attendants.
- Collect advance payments and issue receipts accurately.
- Coordinate with the nursing and front office teams for bed availability.
- Maintain proper records of all transactions, deposits, and admission files.
- Assist in discharge billing preparation by providing advance and service details.
TPA Billing Counter Duties:
- Coordinate with TPA/Insurance companies for pre-authorization and claim processes.
- Submit pre-authorization requests and follow up for approvals.
- Maintain records of approvals, enhancements, and denials.
- Ensure accurate documentation for TPA billing and claims.
- Coordinate with doctors and departments for supporting documents (diagnosis, reports, etc.).
- Prepare final TPA bills and ensure timely submission to insurance/TPA for payment.
- Maintain good liaison with TPA executives and provide updates to patients regarding their claim status.
Required Skills & Competencies:
- Strong knowledge of hospital billing procedures and TPA processes.
- Excellent communication and interpersonal skills.
- Proficiency in hospital management software and MS Office.
- Attention to detail and accuracy in billing.
- Ability to multitask and work under pressure.
- Strong coordination and documentation skills.
Qualification & Experience:
- Qualification: Graduate in Commerce / Hospital Administration / Healthcare Management or equivalent.
- Experience: 13 years of experience in hospital billing and TPA coordination (freshers with relevant knowledge may also apply).
Work Schedule:
- Rotational shifts (including weekends and holidays as per hospital policy).
Key Performance Indicators (KPIs):
- Billing accuracy and timeliness.
- TPA claim approval and settlement rate.
- Patient satisfaction scores.
- Minimal billing discrepancies or rejections.
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