Job Description

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: ₹20,000.00 - ₹35,000.00 per month

Work Location: In person