JOB DESCRIPTION (JD)Position: TPA Executive / TPA Coordinator
Organization: PULMONIC A Multispecialty Hospital
Location: R-9/1, Raj Nagar, Ghaziabad – 201002
Department: TPA / Insurance / Billing
Job Type: Full-Time
Job Summary
We are looking for an experienced and responsible TPA Executive to manage the complete process of insurance, TPA, CGHS and government health scheme patients. The candidate will be responsible for coordination with insurance companies, TPAs, CGHS authorities, hospital departments and patients to ensure smooth admission, cashless authorization, claim processing and settlement.
Key Responsibilities
- Handle TPA, Insurance, CGHS and Ayushman Bharat (PM-JAY) patient cases.
- Manage the complete cashless admission and discharge process.
- Coordinate with various TPAs, Insurance Companies and Government Health Schemes.
- Process Pre-Authorization / Pre-Approval requests for planned and emergency admissions.
- Prepare and submit all required documents for cashless approval.
- Coordinate with doctors, nursing staff, billing and medical records departments.
- Verify patient documents, insurance eligibility and scheme-related requirements.
- Handle CGHS beneficiaries and CGHS-related documentation and billing procedures.
- Handle Ayushman Bharat / PM-JAY cases, including eligibility, authorization and claim-related documentation.
- Prepare and submit final bills, discharge summaries, investigation reports and other required documents.
- Follow up on pending approvals, queries, rejections and claim settlements.
- Coordinate with TPA/Insurance representatives for queries and additional document requirements.
- Maintain proper records of all TPA, Insurance, CGHS and Ayushman cases.
- Ensure timely submission of claims and proper documentation.
- Handle patient and attendant queries professionally.
- Maintain confidentiality of patient and hospital records.
- Perform any other duties assigned by the management.
Required Skills & Qualifications
- Graduate in any discipline; preferably BBA / B.Com / Healthcare Management.
- Minimum 1–3 years of experience in Hospital TPA / Insurance / CGHS / Ayushman work.
- Good knowledge of TPA, Insurance, CGHS and Ayushman Bharat processes.
- Knowledge of Cashless Approval, Pre-Authorization and Claim Settlement.
- Good communication and coordination skills.
- Basic knowledge of MS Office and hospital software.
- Ability to work under pressure and manage multiple cases simultaneously.
- Good knowledge of hospital billing and medical documentation.
Key Competencies
- Excellent communication skills
- Strong coordination and follow-up skills
- Knowledge of TPA and Insurance documentation
- Knowledge of CGHS procedures
- Knowledge of Ayushman Bharat / PM-JAY
- Attention to detail
- Problem-solving ability
- Professional attitude and patient-friendly behavior
Working Hours
8 Hours per Shift
Shift timing may be as per hospital requirements and duty roster.
Salary
As per experience and hospital policy.
Reporting To
HR Manager / Hospital Administration / TPA Department Head
PULMONIC A Multispecialty Hospital
Pay: ₹25,000.00 - ₹35,000.00 per month
Benefits:
- Cell phone reimbursement
- Flexible schedule
- Food provided
- Internet reimbursement
- Leave encashment
- Life insurance
- Paid sick time
- Paid time off
- Provident Fund
- Work from home
Work Location: In person
