Job Description

Job Summary:

The TPA (Third Party Administrator) Manager is responsible for overseeing and managing all TPA and insurance-related operations in the hospital. This includes coordinating with insurance companies, ensuring timely billing and claim settlements, maintaining documentation accuracy, and providing smooth services to insured patients.

Key Responsibilities:

Coordinate with various TPAs, insurance companies, and corporate clients for pre-authorization, claim submission, and settlement. Supervise and guide the TPA team in managing patient admissions, discharge, and documentation for cashless and reimbursement cases. Ensure all claims are filed within stipulated timelines and with complete supporting documents. Monitor the status of pending claims and follow up regularly to ensure prompt payments. Maintain updated records of tariff agreements and MOUs with all TPAs and insurance companies. Reconcile claim settlements and coordinate with the accounts department for payment posting. Handle queries from patients, TPA representatives, and internal departments regarding insurance processes. Prepare periodic reports on claim status, receivables, and TPA performance. Conduct audits of TPA files and ensure compliance with hospital and insurance policies. Liaise with the medical and billing teams to ensure accurate diagnosis, coding, and documentation. Should have knowledge of ESI Billing Management also.

Qualifications & Experience:

Graduate / Postgraduate in Hospital Administration, BAMS, BDS, or a related field. Minimum 5-7 years of experience in TPA / insurance coordination, preferably in a hospital setting. In-depth knowledge of insurance policies, cashless procedures, and medical billing systems.

Key Skills:

Strong communication and negotiation skills. Good analytical and reconciliation ability. Proficiency in MS Office and hospital billing software. Attention to detail and documentation accuracy. Leadership and team management skills.
Job Type: Full-time

Work Location: In person