TPA Executive

2 days ago

Dhanori Pune Maharashtra, India Bapat Multispeciality Hospital Full time ₹ 2,40,000 - ₹ 4,20,000 per year

Department: Billing / Finance / TPA

Reports To: TPA Manager / Billing Head / Hospital Administrator

Employment Type: Full-time

Job Summary:

The TPA (Third Party Administrator) Executive is responsible for coordinating and managing all aspects related to cashless insurance and TPA billing operations in the hospital. This includes pre-authorization, insurance documentation, claim submissions, and following up with TPAs/insurance companies to ensure timely settlement of claims.

Key Responsibilities:

  • Pre-Authorization & Admission Process:
  • Coordinate with the treating doctor to obtain necessary medical information for pre-authorization.
  • Submit pre-authorization requests to the respective TPAs/insurance companies.
  • Follow up for approval and inform patients/attendants accordingly.
  • Insurance Documentation:
  • Collect and verify insurance documents from patients at the time of admission.
  • Ensure all required forms (insurance card, ID proof, policy documents, etc.) are accurately filed.
  • Claim Management:
  • Prepare and submit claims to TPAs/insurance companies with proper documentation.
  • Monitor claim status and follow up for pending payments or rejections.
  • Handle queries and rejections, resubmit claims as needed.
  • Discharge Process:
  • Coordinate with medical, nursing, and billing teams to prepare final bill.
  • Submit final bill to the TPA for final approval before discharge.
  • Ensure timely issuance of discharge summary and final bill approval.
  • Coordination & Communication:
  • Maintain effective communication with patients, insurance companies, TPAs, and internal departments.
  • Explain insurance policies and billing procedures to patients.
  • Reporting & Documentation:
  • Maintain daily reports of admissions, approvals, discharges, and claim submissions.
  • Maintain up-to-date records of insurance companies and TPA contacts.
  • Ensure compliance with internal hospital policies and insurance norms.

Key Skills & Competencies:

  • Knowledge of health insurance policies and TPA processes
  • Good communication and interpersonal skills
  • Attention to detail and accuracy
  • Time management and ability to handle pressure
  • Proficiency in MS Office and hospital billing software (HIS)

Educational Qualifications:

  • Bachelor's degree in any discipline (Commerce, Healthcare Administration preferred)
  • Certification or training in medical billing/TPA management is an advantage

Experience:

  • Minimum 1-3 years of experience in TPA operations or hospital billing
  • Experience in working with multiple insurance providers and TPAs

Job Types: Full-time, Permanent

Pay: ₹20, ₹35,000.00 per month

Work Location: In person

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