Billing And TPA

Job Title: Billing & TPA Executive / Manager

Department: Finance / Revenue Cycle Management

Industry: Hospital / Healthcare

Job Summary

The Billing & TPA Executive/Manager is responsible for managing hospital billing operations, insurance coordination, and Third Party Administrator (TPA) processes to ensure accurate billing, timely claim submission, and optimal revenue realization while complying with hospital policies and regulatory requirements.

Key Responsibilities (Common for Both Roles)

Handle IPD & OPD billing including cash, credit, insurance, and corporate billing

Coordinate with TPAs, insurance companies, and corporate clients

Process pre-authorizations, extensions, and final approvals

Ensure accurate preparation and submission of insurance claims

Verify patient insurance coverage, policy details, and eligibility

Monitor claim status, follow up on pending, rejected, and denied claims

Resolve discrepancies related to billing, coding, and documentation

Maintain proper documentation as per Insurance norms

Coordinate with doctors, nursing staff, front office, and finance team

Ensure compliance with hospital policies and statutory requirements

Maintain MIS reports related to billing, claims, collections, and TAT

Additional Responsibilities – Billing & TPA Executive

Generate provisional and final bills accurately

Collect and verify all clinical and non-clinical documents

Submit claims within stipulated timelines

Update patient and TPA records in the Hospital Information System (HIS)

Support audits and internal reviews

Additional Responsibilities – Billing & TPA Manager

Lead and supervise the Billing & TPA team

Develop and implement billing SOPs and process improvements

Liaise with TPAs/Insurance companies for empanelment and negotiations

Review high-value and complex claims before submission

Analyze rejection trends and implement corrective actions

Ensure achievement of revenue targets and reduction of claim rejections

Prepare and present monthly MIS and performance reports to management

Train and mentor billing & TPA staff

Eligibility & Qualifications

Graduate/Postgraduate in Commerce, Finance, Healthcare Management, or related field

Certification in Medical Billing / Healthcare Management is an added advantage

Experience

Billing & TPA Executive: 1 – 4 years of hospital billing & insurance experience

Billing & TPA Manager: 5 – 8 years of hospital billing & TPA management experience

Skills & Competencies

Strong knowledge of hospital billing, insurance, and TPA processes

Familiarity with ICD, CPT, CGHS, Ayushman Bharat (if applicable)

Proficiency in HIS, MS Excel, and billing software

Excellent communication and coordination skills

Attention to detail and strong problem-solving abilities.

Please WhatsApp your resume: 9353009902

Job Type: Full-time

Pay: ₹20,000.00 - ₹30,000.00 per month

Benefits:

• Provident Fund

Work Location: In person