Qureos Mentor

Bapat Multispeciality Hospital

Department: Billing / Finance / TPA Reports To: TPA Manager / Billing Head / Hospital Administrator Employment Type: Full-timeJob Summary:The TPA (Third Party Administrator) Executive is responsible for coordinating and managing all aspects related to cashless insurance and TPA billing operations in the hospital. This includes pre-authorization, insurance documentation, claim submissions, and following up with TPAs/insurance companies to ensure timely settlement of claims.Key Responsibilities:<ul><li>Pre-Authorization &amp; Admission Process:</li><li>Coordinate with the treating doctor to obtain necessary medical information for pre-authorization.</li><li>Submit pre-authorization requests to the respective TPAs/insurance companies.</li><li>Follow up for approval and inform patients/attendants accordingly.</li><li>Insurance Documentation:</li><li>Collect and verify insurance documents from patients at the time of admission.</li><li>Ensure all required forms (insurance card, ID proof, policy documents, etc.) are accurately filed.</li><li>Claim Management:</li><li>Prepare and submit claims to TPAs/insurance companies with proper documentation.</li><li>Monitor claim status and follow up for pending payments or rejections.</li><li>Handle queries and rejections, resubmit claims as needed.</li><li>Discharge Process:</li><li>Coordinate with medical, nursing, and billing teams to prepare final bill.</li><li>Submit final bill to the TPA for final approval before discharge.</li><li>Ensure timely issuance of discharge summary and final bill approval.</li><li>Coordination &amp; Communication:</li><li>Maintain effective communication with patients, insurance companies, TPAs, and internal departments.</li><li>Explain insurance policies and billing procedures to patients.</li><li>Reporting &amp; Documentation:</li><li>Maintain daily reports of admissions, approvals, discharges, and claim submissions.</li><li>Maintain up-to-date records of insurance companies and TPA contacts.</li><li>Ensure compliance with internal hospital policies and insurance norms.</li></ul>Key Skills &amp; Competencies:<ul><li>Knowledge of health insurance policies and TPA processes</li><li>Good communication and interpersonal skills</li><li>Attention to detail and accuracy</li><li>Time management and ability to handle pressure</li><li>Proficiency in MS Office and hospital billing software (HIS)</li></ul>Educational Qualifications:<ul><li>Bachelor's degree in any discipline (Commerce, Healthcare Administration preferred)</li><li>Certification or training in medical billing/TPA management is an advantage</li></ul>Experience:<ul><li>Minimum 1-3 years of experience in TPA operations or hospital billing</li><li>Experience in working with multiple insurance providers and TPAs</li></ul>Job Types: Full-time, PermanentPay: &#8377;20,000.00 - &#8377;35,000.00 per monthWork Location: In person

TPA Executive

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Bapat Multispeciality Hospital

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TPA Executive