tpa coordinator

SRV Group Hospital- Multispeciality

Job Title: Billing &amp; TPA Executive / ManagerDepartment: Finance / Revenue Cycle ManagementIndustry: Hospital / HealthcareJob SummaryThe Billing &amp; 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 &amp; OPD billing including cash, credit, insurance, and corporate billingCoordinate with TPAs, insurance companies, and corporate clientsProcess pre-authorizations, extensions, and final approvalsEnsure accurate preparation and submission of insurance claimsVerify patient insurance coverage, policy details, and eligibilityMonitor claim status, follow up on pending, rejected, and denied claimsResolve discrepancies related to billing, coding, and documentationMaintain proper documentation as per Insurance normsCoordinate with doctors, nursing staff, front office, and finance teamEnsure compliance with hospital policies and statutory requirementsMaintain MIS reports related to billing, claims, collections, and TATAdditional Responsibilities &ndash; Billing &amp; TPA ExecutiveGenerate provisional and final bills accuratelyCollect and verify all clinical and non-clinical documentsSubmit claims within stipulated timelinesUpdate patient and TPA records in the Hospital Information System (HIS)Support audits and internal reviewsAdditional Responsibilities &ndash; Billing &amp; TPA ManagerLead and supervise the Billing &amp; TPA teamDevelop and implement billing SOPs and process improvementsLiaise with TPAs/Insurance companies for empanelment and negotiationsReview high-value and complex claims before submissionAnalyze rejection trends and implement corrective actionsEnsure achievement of revenue targets and reduction of claim rejectionsPrepare and present monthly MIS and performance reports to managementTrain and mentor billing &amp; TPA staffEligibility &amp; QualificationsGraduate/Postgraduate in Commerce, Finance, Healthcare Management, or related fieldCertification in Medical Billing / Healthcare Management is an added advantageExperienceBilling &amp; TPA Executive: 1 &ndash; 4 years of hospital billing &amp; insurance experienceBilling &amp; TPA Manager: 5 &ndash; 8 years of hospital billing &amp; TPA management experienceSkills &amp; CompetenciesStrong knowledge of hospital billing, insurance, and TPA processesFamiliarity with ICD, CPT, CGHS, Ayushman Bharat (if applicable)Proficiency in HIS, MS Excel, and billing softwareExcellent communication and coordination skillsAttention to detail and strong problem-solving abilities.Please WhatsApp your resume: 9353009902Job Type: Full-timePay: ₹20,000.00 - ₹30,000.00 per monthBenefits:<ul><li>Provident Fund</li></ul>Work Location: In person

Billing And TPA

The Healing Touch Eye Centre

Urgent Hiring&hellip;!!!Job Title: Senior TPA Executive &ndash; Eye HospitalDepartment: TPA / Insurance / BillingJob Summary:The Senior TPA Executive is responsible for managing end-to-end TPA and insurance processes for eye care procedures, ensuring accurate billing, timely approvals, claim submission, and smooth coordination with TPAs, insurers, doctors, and internal teams to ensure maximum revenue realization and patient satisfaction.Skills &amp; Competencies:<ul><li>Strong knowledge of eye hospital billing, packages, and TPA processes</li><li>Familiarity with ophthalmology procedures and insurance coverage norms</li><li>Good communication and coordination skills</li><li>Attention to detail and documentation accuracy</li><li>Working knowledge of HIS / billing software and MS Excel</li><li>Ability to handle multiple cases and meet deadlines</li></ul>Qualifications:<ul><li>Graduate in any discipline </li></ul>Experience:<ul><li>3&ndash;6 years of experience in TPA &amp; insurance operations, preferably in an eye hospital or specialty hospital</li></ul># Immediate JoinerEmail ID: thehealingtouch.hr1@gmail.comJob Types: Full-time, PermanentPay: ₹20,000.00 - ₹35,000.00 per monthBenefits:<ul><li>Paid sick time</li><li>Provident Fund</li></ul>Work Location: In person

Senior TPA Executive

Shalby Limited

Job Purpose:The Assistant Manager &ndash; Billing / TPA is responsible for overseeing billing operations, TPA coordination, audits, and compliance to ensure accurate revenue realization and adherence to hospital policies. The role supports efficient billing processes across cash, TPA, and corporate segments using TCS HIS software.Key Responsibilities:<ul><li>Prepare, update, and maintain Schedule of Charges (SOC) for Cash, TPA, and Corporate billing</li><li>Prepare and validate Doctor Payout statements on a monthly basis</li><li>Prepare financial and operational MIS reports for management review</li><li>Design, update, and maintain surgical and procedure packages</li><li>Justify and reconcile actual bills against estimated bills for discharged patients</li><li>Monitor billing accuracy and identify discrepancies or revenue leakages</li><li>Ensure compliance with hospital policies, internal controls, and applicable regulatory guidelines</li><li>Coordinate with billing, clinical, TPA, and insurance teams to resolve billing hurdles and escalations</li><li>Support audits (internal / external) and ensure timely closure of observations</li><li>Guide and supervise billing executives to ensure process adherence and accuracy.</li></ul>Skills &amp; Competencies:<ul><li>Strong knowledge of hospital billing, TPA processes, and packages</li><li>Hands-on experience with HIS (TCS HIS preferred)</li><li>Proficiency in MIS preparation and data analysis</li><li>Good understanding of insurance guidelines and compliance</li><li>Strong coordination, communication, and problem-solving skills</li><li>Attention to detail and audit orientation</li></ul>Job Type: Full-timePay: ₹30,000.00 - ₹40,000.00 per monthWork Location: In person

Billing / TPA - Senior Executive

Siddhachal Life Care Hospital

The Cath Lab Coordinator oversees the daily operations of the Cardiac Catheterization Lab, ensuring efficient patient flow, high-quality care, and adherence to safety protocols, acting as a leader and liaison for the clinical team. Key Responsibilities:<ul><li>Operations &amp; Scheduling.</li><li>Patient Care</li><li>Team Leadership</li><li>Resource Management</li><li>Physician Collaboration</li><li>Quality &amp; Compliance</li></ul>Qualifications:<ul><li>Education: Associate's/Bachelor's Degree in Nursing or relevant field.</li><li>Licensure: Current RN license (if applicable).</li><li>Experience: 3year Proven experience in cardiac cath lab procedures and leadership roles.</li><li>Skills: Strong clinical judgment, excellent communication, problem-solving, and teamwork.</li></ul>we are Looking for the coordinator who will coordinate with Patient, Doctor, TPA. Also have knowledge about cath-lab working , A coordinator who will able to explain about bookings, finance &amp; Insurance to the patients and able to make budget accordingly. Coordinator must have good communication skills &amp; good presence of mind to deal with patient &amp; other working people in hospital surrounding.Job Types: Full-time, PermanentPay: ₹20,000.00 - ₹30,000.00 per monthBenefits:<ul><li>Provident Fund</li></ul>Work Location: In person

Cath Lab Coordinator

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

Nucleon Health

<div>
 
 
 Job Title:
 
 Medical Officer / TPA Doctor
 
 
 
 Reporting To:
 
 CFO
 
 
 &nbsp;
 
 
 
 Job Purpose:
 
 
 
 To evaluate, process, and approve health insurance claims, provide medical opinions, and ensure compliance with policy terms, medical guidelines, and regulatory standards for the TPA.
 
 
 &nbsp;
 
 
 
 Key Responsibilities:
 
 
 
 &nbsp;
 
 
 Claims &amp; Pre-Authorization:
 
 
 - Review and process cashless pre-authorization requests from network hospitals.
 
 
 - Assess medical necessity, diagnosis, treatment plans, and estimated costs.
 
 
 - Approve, query, or deny requests as per policy terms and medical protocols.
 
 
 - Review final bills and discharge summaries for claim settlement.
 
 
 &nbsp;
 
 
 Medical Evaluation:
 
 
 - Provide medical opinions on hospitalization, procedures, and length of stay.
 
 
 - Identify non-admissible expenses and policy exclusions.
 
 
 - Ensure adherence to standard treatment guidelines (STGs).
 
 
 &nbsp;
 
 
 Coordination &amp; Communication:
 
 
 - Coordinate with network hospitals, treating doctors, and TPA operations teams.
 
 
 - Clarify medical queries with hospitals for claim processing.
 
 
 - Support customer service teams for medical escalations.
 
 
 &nbsp;
 
 
 Compliance &amp; Documentation:
 
 
 - Ensure compliance with IRDAI guidelines, insurer policies, and internal SOPs.
 
 
 - Maintain proper medical documentation and audit trails.
 
 
 - Support internal and external audits.
 
 
 &nbsp;
 
 
 Quality &amp; Fraud Control:
 
 
 - Assist in fraud detection, abuse, and overbilling cases.
 
 
 - Flag suspicious or high-risk claims for investigation.
 
 
 - Participate in claim quality reviews and process improvements.
 
 
 &nbsp;
 
 
 
 Qualifications:
 
 
 
 - MBBS, BHMS, BAMS
 
 
 - Valid Medical Council registration (NMC / State Medical Council)
 
 
 &nbsp;
 
 
 
 Experience:
 
 
 
 - 1&ndash;5 years of clinical or TPA/insurance experience
 
 
 - Experience in claims processing / pre-authorization is an advantage
 
 
 - Fresh MBBS candidates may be considered for junior roles
 
 
 &nbsp;
 
 
 
 Skills &amp; Competencies:
 
 
 
 - Strong knowledge of clinical protocols and medical terminology
 
 
 - Understanding of health insurance policies and claim processes
 
 
 - Good analytical and decision-making skills
 
 
 - Excellent communication and documentation skills
 
 
 - Basic computer knowledge (HIS, TPA portals, MS Office)
 
 
 &nbsp;
 
 
 
 Work Environment:
 
 
 
 - Office-based / Hybrid (as per company policy)
 
 
 - Rotational shifts may apply
 
 
 &nbsp;
 
 
 
 Key Performance Indicators (KPIs):
 
 
 
 - Claim turnaround time (TAT)
 
 
 - Accuracy of medical decisions
 
 
 - Compliance and audit scores
 
 
 - Quality of documentation
 
</div>

Medical Officer (TPA Doctor)

Mahajan Eye Centre

Patient Financial Counsellor(Eye Care Services)Organization: Mahajan Eye Centre Location: PITAMPURA, Delhi NCR Employment Type: Full-timeAbout Mahajan Eye CentreMahajan Eye Centre is a reputed eye care hospital committed to ethical practices, transparency, and patient-centric care. We provide comprehensive ophthalmic services including OPD, diagnostics, and surgical treatments.Job SummaryWe are seeking a Patient Financial Counsellor responsible for explaining treatment costs, surgery packages, lens options, and insurance/TPA processes to patients in a clear and transparent manner. The role requires balancing financial counselling with empathy, ethics, and patient trust.Key ResponsibilitiesFinancial Counselling<ul><li>Explain procedure-wise cost estimates for cataract, refractive, and other eye surgeries</li><li>Counsel patients on lens options, surgery packages, inclusions &amp; exclusions</li><li>Provide clear explanation of billing structure and payment options</li><li>Address patient queries related to costs, packages, and financial planning</li></ul>Insurance / TPA Coordination<ul><li>Explain cashless insurance process, eligibility, and documentation requirements</li><li>Coordinate with billing &amp; TPA teams for estimates, pre-authorizations, and approvals</li><li>Inform patients about policy limitations, non-payables, and co-payments</li><li>Assist patients till financial clearance before surgery</li></ul>Coordination &amp; Documentation<ul><li>Coordinate with doctors, optometrists, OT, and billing teams</li><li>Ensure consent forms, estimates, and financial documents are completed</li><li>Maintain accurate counselling records and conversion tracking</li><li>Follow ethical counselling standards&mdash;no misrepresentation or pressure selling</li></ul>Required Qualifications &amp; Skills<ul><li>Graduate (Commerce / Healthcare background preferred)</li><li>1&ndash;3 years experience as Financial Counsellor / Billing Counsellor / Eye Counsellor</li><li>Good knowledge of:</li><li>Cataract surgery &amp; IOL pricing</li><li>Eye hospital packages</li><li>TPA &amp; insurance workflows</li><li>Strong communication skills in Hindi &amp; English</li><li>Patient-friendly, confident, and ethical approach</li><li>Ability to handle objections and financial discussions calmly</li></ul>What We Offer<ul><li>Ethical and transparent work culture</li><li>Structured counselling processes</li><li>Learning exposure in eye hospital financial operations</li><li>Competitive salary with performance-based incentives</li></ul>Job Type: Full-timePay: ₹14,303.85 - ₹25,000.00 per monthWork Location: In person

Patient Financial Counsellor – Ophthalmology

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