Credit / TPA MANAGER

1. TPA & Insurance Coordination

• Act as the primary liaison between the hospital and all empaneled TPAs and insurance companies.
• Ensure all documentation required for cashless and reimbursement claims is complete and submitted on time.

2. Cashless Authorization

• Facilitate the process of obtaining pre-authorization approvals for cashless treatments.
• Monitor turnaround time for approval and escalate delays as necessary.
• Coordinate with doctors and departments for timely medical information required by TPAs.

3. Claims Processing & Documentation

• Oversee preparation and submission of final bills and discharge summaries to TPAs.
• Ensure all claims are submitted accurately with complete supporting documents.
• Monitor the status of submitted claims and follow up regularly until settlement.

4. Reimbursement Follow-ups

• Track claim rejections or short payments.
• Reconcile accounts and resubmit or appeal denied claims with justifications.
• Maintain communication with patients about the status of their insurance claims.

5. Empanelment & TPA Agreements

• Manage TPA empanelment processes and documentation.
• Review and renew contracts with TPAs and insurance companies as needed.

6. MIS & Reporting

• Maintain updated records of all cashless and reimbursement claims.
• Generate daily/weekly/monthly reports on claim status, approvals, rejections, and payments received.
• Analyze data to identify bottlenecks or trends in claim rejections.

7. Team Management

• Supervise and train the TPA desk staff.
• Allocate duties, monitor performance, and ensure quality service.

8. Patient Support & Counselling

• Educate patients about their insurance policies, entitlements, and the claim process.
• Assist patients in completing necessary paperwork.
• Address grievances related to delays or denials of claims.

9. Compliance & Audit

• Ensure compliance with IRDAI guidelines and other regulatory requirements.
• Prepare for audits by TPAs or insurance companies and respond to audit queries.

10. Coordination with Internal Departments

• Work closely with billing, admission, discharge, and medical records departments.
• Ensure seamless flow of information for cashless and reimbursement processing.

Job Type: Full-time

Pay: ₹20,000.00 - ₹50,000.00 per month

Benefits:

• Cell phone reimbursement
• Paid sick time
• Provident Fund

Work Location: In person