TPA Coordinator
Department: Billing & Insurance
Reports To: Billing Manager / Finance Manager / Hospital Administrator
Location: Hopewell Hospital, Ranchi
Employment Type: Full-Time
Position Summary
The TPA Coordinator is responsible for the complete management of cashless insurance, corporate, government health schemes, and reimbursement cases. The role ensures timely pre-authorizations, accurate documentation, effective coordination with insurance companies and TPAs, prompt claim settlements, and an excellent patient experience throughout the hospitalization.
The coordinator acts as the bridge between patients, doctors, nursing, billing, insurance companies, TPAs, and internal hospital departments.
Key Responsibilities
1. Cashless Admission Management
- Verify patient's insurance eligibility.
- Check policy coverage and exclusions.
- Explain cashless process to patients and relatives.
- Coordinate with admission desk before admitting insured patients.
- Obtain all necessary insurance documents.
2. Pre-Authorization
- Prepare and submit pre-authorization requests.
- Coordinate with consultants for clinical documents.
- Follow up continuously until approval.
- Escalate delayed approvals.
- Maintain approval timelines.
3. Documentation
Collect and verify:
- Insurance card
- Identity proof
- Policy copy
- Claim forms
- KYC documents
- Consultant notes
- Investigation reports
- Consent forms
- OT notes
- Discharge summary
- Final bill
- Pharmacy records
- Implant stickers
- Investigation films/reports
Ensure zero documentation deficiencies.
4. Insurance Coordination
Coordinate with:
- TPAs
- Insurance Companies
- Corporate Insurance Panels
- Government Health Schemes
- Surveyors
- Medical Auditors
Maintain professional communication throughout the patient journey.
5. Billing Coordination
Work closely with billing team to ensure:
- Accurate package billing
- Non-payable identification
- Excluded items explained to patient
- Timely bill updates
- Final bill submission
6. Query Management
- Respond to insurer queries immediately.
- Coordinate with treating consultants for clinical clarifications.
- Submit revised documents.
- Reduce claim turnaround time.
7. Discharge Clearance
Ensure:
- Final authorization received.
- Billing completed.
- Patient liabilities collected.
- Discharge approval obtained.
- Discharge delays minimized.
8. Reimbursement Cases
Assist patients with:
- Claim forms
- Documentation
- Hospital certificates
- Bills
- Investigation reports
- Discharge summaries
Ensure complete reimbursement documentation.
9. Corporate & Government Scheme Coordination
Coordinate cases under:
- Ayushman Bharat (AB-PMJAY)
- CGHS
- ECHS
- State Government Schemes
- Corporate Tie-ups
- PSU Insurance
Ensure compliance with scheme guidelines.
10. Claim Settlement Support
- Track pending claims.
- Follow outstanding settlements.
- Coordinate with finance.
- Monitor ageing.
- Reduce outstanding receivables.
11. Record Management
Maintain:
- Daily cashless admissions
- Pending approvals
- Pending queries
- Discharge approvals
- Outstanding claims
- Rejected claims
- Claim settlement tracker
- TPA-wise statistics
Daily Responsibilities
- Verify all new insurance admissions.
- Process pre-authorizations.
- Follow up pending approvals.
- Attend insurer queries.
- Coordinate discharge approvals.
- Update claim tracker.
- Report pending cases to management.
Weekly Responsibilities
- Review pending claims.
- Ageing analysis.
- TPA performance review.
- Claim rejection analysis.
- Documentation audit.
- Coordination meeting with billing team.
Monthly Responsibilities
Prepare reports on:
- Total insurance admissions
- Cashless approvals
- Average approval time
- Claim settlement percentage
- Outstanding claims
- Ageing report
- TPA-wise business
- Corporate-wise business
- Rejection analysis
- Revenue from insurance patients
Required Qualifications
- Graduate in any discipline (Healthcare Administration preferred).
- Diploma/Degree in Hospital Administration is desirable.
- 2–5 years of experience in TPA/Insurance coordination in a multispeciality hospital.
- Knowledge of insurance processes and cashless workflows.
- Familiarity with AB-PMJAY and government schemes is preferred.
Required SkillsTechnical Skills
- Hospital Information System (HIS)
- Insurance Portals
- MS Excel
- Documentation Management
- Medical Terminology
- ICD Coding (basic understanding)
- Package Billing
Soft Skills
- Excellent communication
- Negotiation skills
- Attention to detail
- Time management
- Problem-solving
- Patient counselling
- Professional etiquette
Internal
- Consultants
- Nursing
- Billing
- Reception
- Medical Records Department (MRD)
- Pharmacy
- Laboratory
- Radiology
- Finance
- Hospital Administration
External
- TPAs
- Insurance Companies
- Corporate Clients
- Government Health Scheme Authorities
- Medical Auditors
- Surveyors
Ideal Candidate Profile
The ideal TPA Coordinator for Hopewell Hospital should be meticulous, patient-centric, and highly organized. They must possess strong knowledge of insurance workflows, excellent follow-up skills, and the ability to coordinate effectively across clinical and administrative teams. Their primary objective is to ensure fast approvals, minimal discharge delays, accurate documentation, reduced claim rejections, and an exceptional cashless hospitalization experience for every patient.
Pay: ₹25,000.00 - ₹45,000.00 per month
Benefits:
Work Location: In person
