Qureos Mentor

Edison Hospital

The TPA Head will be responsible for overseeing all Third-Party Administrator (TPA) and insurance-related activities in the hospital. The role involves managing cashless processes, billing approvals, claims settlement, coordination with insurance companies, and ensuring compliance with regulatory requirements.Key Responsibilities:1. Operations Management<ul><li>Supervise and monitor the entire TPA and insurance operations of the hospital.</li><li>Ensure timely and accurate processing of pre-authorizations, approvals, and discharge summaries.</li><li>Maintain coordination between patients, doctors, billing, and TPA executives for smooth cashless operations.</li><li>Oversee the claim submission process and follow up on pending or rejected claims.</li><li>Ensure accuracy of documentation and adherence to insurance/TPA guidelines.</li></ul>2. Financial &amp; Claims Management<ul><li>Review and approve all insurance and TPA-related bills before submission.</li><li>Monitor claim settlements and ensure timely payments from insurance companies.</li><li>Track receivables, reconcile accounts, and minimize claim rejections.</li><li>Prepare MIS reports on TPA collections, outstanding claims, and rejections.</li></ul>3. Coordination &amp; Liaison<ul><li>Build and maintain strong relationships with TPA representatives and insurance companies.</li><li>Liaise with consultants and clinical teams for proper documentation and justification of medical procedures.</li><li>Act as a point of escalation for complex or disputed cases.</li></ul>4. Team Management<ul><li>Lead, train, and monitor the TPA team to ensure efficiency and service quality.</li><li>Allocate responsibilities and monitor daily operations to maintain turnaround times.</li></ul>5. Compliance &amp; Quality<ul><li>Ensure compliance with hospital policies and IRDA guidelines.</li><li>Periodically audit insurance files and claim documentation.</li><li>Implement continuous process improvement in TPA operations.</li></ul>Key Skills &amp; Competencies:<ul><li>Strong knowledge of hospital billing, insurance procedures, and TPA processes</li><li>Excellent communication and negotiation skills</li><li>Analytical and problem-solving ability</li><li>Team leadership and multitasking skills</li><li>Proficiency in hospital billing software and MS Office</li></ul>Qualification:<ul><li>Graduate in any discipline</li><li>Experience: Minimum 2 years in TPA/Insurance coordination</li></ul>Job Type: Full-timePay: ₹13,000.00 - ₹35,000.04 per monthWork Location: In person

TPA Executive

Join Edison Hospital and explore 1   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.

Edison Hospital

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TPA Executive