tpa and cghs executive

Job Summary:
We are looking for an experienced professional to manage and coordinate all activities related to TPAs and government/corporate schemes including CGHS, ECHS, Naval, Air India, and other empanelments in an ophthalmology setup. The role involves handling approvals, documentation, billing, coordination with patients and departments, and ensuring smooth claim processing.

Key Responsibilities:

• Handle end-to-end coordination for TPA, CGHS, ECHS, Naval, Air India, and other scheme patients.
• Verify eligibility, documents, and entitlement as per scheme guidelines.
• Process pre-authorizations and obtain approvals for ophthalmic procedures (cataract, retina, cornea, etc.).
• Coordinate with doctors, OT team, billing, and front office for smooth patient flow.
• Prepare and submit claims with accurate documentation within timelines.
• Follow up with TPAs and authorities for approvals, queries, and claim settlements.
• Maintain records, registers, and scheme-wise reports.
• Ensure compliance with package rates, policies, and audit requirements.
• Handle claim rejections, discrepancies, and resubmissions.
• Provide guidance to patients regarding scheme processes and documentation.
• Assist during inspections, audits, and empanelment renewals.

Required Skills & Qualifications:

• Experience in handling TPA and government schemes (CGHS, ECHS, Naval, Air India) in a hospital, preferably ophthalmology.
• Good knowledge of ophthalmic procedures and package billing.
• Strong documentation and coordination skills.
• Familiarity with hospital software and claim portals.
• Good communication and patient handling skills.
• Attention to detail and ability to work under deadlines.

Experience:

• Minimum 2–5 years in TPA / scheme handling in healthcare (ophthalmology preferred).

Education:

• Graduate in any field (Healthcare administration background preferred).

Job Types: Full-time, Permanent

Pay: ₹10,422.28 - ₹34,811.80 per month

Work Location: In person