Job Description

As a Hospital TPA Coordinator, you will be responsible for managing the relationships and administrative processes related to third-party administrators, such as insurance companies and managed care organizations. Your role involves facilitating communication, ensuring timely processing of claims, and maintaining compliance with contractual agreements and regulatory requirements.

Responsibilities

:

Claims Processing

: Receive, review, and process insurance claims submitted by patients or healthcare providers. Verify patient eligibility and coverage details with the TPA. Ensure claims are submitted accurately and promptly to maximize reimbursement.

Communication and Coordination

: Serve as the primary point of contact between the hospital and TPAs. Communicate effectively with TPAs to resolve claim issues, denials, and payment discrepancies. Collaborate with hospital billing and finance departments to streamline claim processing.

Contract Management

: Monitor and enforce contractual agreements with TPAs to ensure compliance. Negotiate rates and terms for services provided to insured patients. Update and maintain contract documentation and records.

Documentation and Reporting

: Maintain accurate records of TPA communications, claims status, and payments. Generate reports on claim processing metrics, reimbursement rates, and trends. Provide regular updates to hospital management on TPA performance and financial impact.

Quality Assurance and Compliance

: Ensure compliance with healthcare regulations and TPA requirements. Implement quality assurance measures to minimize claim errors and optimize reimbursement.

Patient Advocacy

: Assist patients with understanding their insurance coverage, benefits, and responsibilities. Advocate on behalf of patients to resolve insurance-related issues and ensure fair reimbursement.
Job Types: Full-time, Permanent

Schedule:

Day shift Fixed shift
Supplemental Pay:

Overtime pay
Experience:

total work: 1 year (Preferred)
Work Location: In person