Key Responsibilities of a TPA Coordinator
Core Responsibilities1. Insurance & TPA Coordination
- Coordinate with insurance companies and TPAs for cashless hospitalization approvals.
- Handle pre-authorization and claim documentation processes.
- Follow up on pending approvals, claim settlements, and reimbursement status.
- Maintain strong communication with TPAs, insurance representatives, and hospital departments.
2. Patient Assistance
- Guide patients and attendants regarding insurance procedures and required documents.
- Explain cashless policies, coverage details, exclusions, and claim processes.
- Assist patients during admission and discharge formalities related to insurance.
3. Documentation Management
- Verify patient insurance documents and policy details.
- Ensure accurate preparation and submission of claim forms, bills, discharge summaries, investigation reports, and supporting documents.
- Maintain records of approvals, denials, claims, and settlements.
4. Billing & Claim Processing
- Coordinate with the billing department for accurate insurance billing.
- Review hospital bills as per TPA guidelines and package rates.
- Resolve billing discrepancies and claim-related queries.
5. Claim Follow-Up & Settlement
- Track pending claims and ensure timely settlement.
- Handle claim rejections, denials, deductions, and resubmissions.
- Prepare daily and monthly MIS reports related to TPA operations.
6. Compliance & Policy Adherence
- Ensure compliance with hospital policies, insurance regulations, and TPA guidelines.
- Keep updated with changes in insurance policies and healthcare regulations.
7. Coordination with Internal Departments
- Work closely with doctors, nursing staff, front office, medical records, and accounts departments.
- Ensure smooth patient discharge process after final approval.
Pay: ₹11,000.00 - ₹20,000.00 per month
Work Location: In person
