A TPA (Third-Party Administrator) Executive in a hospital acts as the crucial link between patients, insurance companies, and the hospital, managing insurance claims, pre-authorizations, and discharge processes. They ensure smooth cashless transactions, verify documentation for compliance, and provide guidance to patients regarding insurance benefits. Indeed +2Key Responsibilities:
- Cashless Claims Management: Initiating, monitoring, and obtaining approval for cashless treatment requests from TPAs and insurance companies, ensuring they are handled within defined timelines.
- Patient Counseling & Documentation: Verifying patient insurance eligibility, guiding families on policy coverage, and organizing necessary documentation (ID proof, health cards, doctor reports).
- Billing & Coordination: Collaborating with the hospital billing department for bill reconciliation, preparing final invoices for TPA submission, and handling queries at discharge.
- TPA Portal Handling: Maintaining patient records, uploading documents, and updating claim statuses accurately on various TPA portals.
- Follow-ups & Reporting: Conducting follow-ups on pending approvals or payments and preparing daily/monthly reports on claim status for hospital management.
- Dispute Resolution: Addressing disputes or rejections regarding insurance claims between the insurer and the hospital. Indeed +4
Skills and Qualifications:
- Education: Bachelor’s degree in any discipline or experience in healthcare administration.
- Experience: Usually 1–3 years of experience in hospital billing or TPA departments.
- Skills: Strong communication, interpersonal skills, proficiency in hospital information systems (HIS), and knowledge of medical terminology and insurance norms. Indeed +4
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Job Type: Full-time
Pay: ₹12,000.00 - ₹25,000.00 per month
Experience:
- total work: 1 year (Preferred)
Work Location: In person
