Job Description

TPA Coordinator

acts as a bridge between the

hospital, insurance companies

, and

patients

, handling all matters related to

cashless insurance claims

,

pre-authorizations

, and

reimbursements

. They ensure smooth processing of documents and compliance with TPA policies for both insured patients and the hospital.

Key Roles & Responsibilities

Insurance Processing

Facilitate

pre-authorization

for cashless treatments by submitting medical documents to TPAs. Track approval status and communicate decisions to patients and billing team. Handle

reimbursement cases

by preparing and submitting proper documentation to insurance companies.

Documentation & Coordination

Collect and verify required documents from patients (ID proof, insurance card, policy documents, etc.). Coordinate with doctors and departments to get accurate treatment details and discharge summaries. Submit final bills and medical records to TPA for settlement.

Patient Interaction

Explain the

insurance claim process

to patients and their families. Help patients choose eligible insurance packages or inform them about exclusions. Handle patient queries or grievances related to insurance.

Billing & Claims Follow-Up

Work closely with the billing department to prepare and finalize claims. Follow up with TPA for

pending or rejected claims

. Maintain records of all claims filed, approvals, rejections, and payments received.

Compliance & Audit

Ensure compliance with

IRDAI

(Insurance Regulatory and Development Authority of India) and hospital policies. Prepare reports for hospital management or audits as needed.

Skills Required

Knowledge of medical insurance processes Familiarity with hospital billing software (e.g., MediAssist, MedNet, FHPL, HealthIndia) Good communication and interpersonal skills Attention to detail in documentation Ability to handle pressure and coordinate across departments Basic medical terminology (useful when handling diagnosis/procedures)

Qualification

Minimum

: Graduate (any stream, preferably B.Com, BBA, or BA)

Preferred

: Diploma or certification in Hospital Administration, TPA, or Medical Billing Basic computer and typing skills are essential Previous experience in hospital front office or billing is a plus

Typical Work Environment

Hospital Front Office / Insurance Desk
Job Types: Full-time, Permanent

Pay: From ?20,000.00 per month

Work Location: In person