Qureos Mentor

Acharya Shri Nanesh Hospital

<ul><li>Job Summary: Manage TPA (Third Party Administrator) operations, ensuring efficient processing of health claims. Coordinate with healthcare providers, insurers, and customers to resolve claim-related issues. Analyze data to identify trends and areas for improvement in the claims process.</li></ul>Responsibilities<ul><li>Coordinate with healthcare providers, insurance companies, and patients to resolve claims-related issues.</li></ul><ul><li>Process patient claims from admission to discharge, ensuring accurate and timely payment.</li></ul><ul><li>Manage TPA (Third Party Administrator) activities, including claim settlements and reconciliations.</li></ul><ul><li>Maintain CRM (Customer Relationship Management) software to track customer interactions and updates.</li></ul><ul><li>Ensure compliance with regulatory requirements for medical insurance policies. Handling TPA related all process from billing to co-ordinate with TPA companies.</li></ul><ul><li>Responsible for counselling patient's family &amp; pre-Auth process.</li></ul><ul><li>Maintaining &amp; uploading patient's files on the portal.</li></ul><ul><li>Couriering the hard copy of patient's medical file to the Insurance companies.</li></ul><ul><li>Responsible for all co-ordination activities from patient's admission to discharge.</li></ul><ul><li>Handling billing Department, Implants bill updating &amp; reconciliation.</li></ul><ul><li>Daily co-ordination with the patient and Hospital staff.</li></ul><ul><li>Preparing split bills/ Doctor charges etc.</li></ul><ul><li>Handling all TPA Portals.</li></ul><ul><li>Outstanding follow-up with TPA.</li></ul><ul><li>Monthly Review report.</li></ul><ul><li>To obtain and review referrals and authorizations for treatments.</li></ul><ul><li>To follow and adhere to all regulations and guidelines set by state programs, and HMO/PPO, etc.</li></ul><ul><li>Must be aware of norms of the insurance sector.</li></ul><ul><li>Daily follow up with Insurance companies to pass or clear the Health Insurance claims.</li></ul>Job Types: Full-time, Permanent, FresherPay: &#8377;20,127.64 - &#8377;27,681.51 per monthBenefits:<ul><li>Leave encashment</li><li>Provident Fund</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Work Location: In person

TPA Executive

<ul><li>Provide high-quality patient care.</li><li>Assist with the continuous development of staff.</li><li>Identify hazards in the workplace and provide solutions</li><li>Treat emergency injuries.</li><li>Develop programs to maintain health and safety.</li><li>Identify work-related risks.</li><li>Document all injuries and illnesses.</li><li>Monitor exact, detailed reports and records of the critical ICU patients.</li><li>Monitor and record symptoms and changes in patients' conditions and information to the physician.</li></ul>Job Type: Full-timePay: &#8377;20,000.00 - &#8377;25,000.00 per monthBenefits:<ul><li>Internet reimbursement</li><li>Leave encashment</li></ul>Ability to commute/relocate:<ul><li>Navi Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (Required)</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Nursing: 1 year (Required)</li></ul>License/Certification:<ul><li>CERTIFICATION (Required)</li></ul>

Registered Staff Nurse

Join Acharya Shri Nanesh Hospital and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Acharya Shri Nanesh Hospital

ABOUT_COMPANY

TPA Executive

Registered Staff Nurse