TPA BILLING EXECUTIVE

The TPA Billing Executive will be responsible for handling all insurance-related billing activities, ensuring accurate documentation, timely submission of claims, coordination with TPAs, and smooth processing of approvals for patients. The role requires strong communication, attention to detail, and a good understanding of medical billing processes.

Key Responsibilities:1. Insurance & TPA Coordination

• Handle patient insurance queries and guide them through the cashless or reimbursement process.
• Verify insurance eligibility, policy coverage, and required documentation.
• Coordinate with Third-Party Administrators (TPAs) for pre-authorization, approvals, and queries.

2. Billing & Documentation

• Prepare and submit accurate bills for TPA/cashless cases.
• Ensure all investigations, procedures, and services are billed correctly.
• Maintain proper records of authorization letters, approvals, and billing documents.
• Upload required documents on TPA portals as per guidelines.

3. Claim Management

• Track claim status, follow up for approvals, and escalate delays when required.
• Handle re-submissions and resolve query responses raised by TPAs.
• Ensure timely closure of all cashless cases.

4. Internal Coordination

• Coordinate with doctors, optometrists, counselors, and billing staff to ensure accurate information flow.
• Obtain necessary medical reports, operative notes, and prescriptions for claims.

5. Compliance & Reporting

• Ensure adherence to insurance guidelines and hospital protocols.
• Maintain daily MIS reports for TPA cases, pending cases, and approval status.
• Flag discrepancies or issues to the Centre Manager promptly.

Required Skills & Qualifications:

• Minimum 1–3 years of experience in healthcare billing or TPA processes.
• Knowledge of cashless and reimbursement procedures, TPA portals, and documentation.
• Good communication skills (English & Hindi).
• Strong attention to detail and accuracy.
• Basic computer knowledge (Excel, Email, Billing Software).

Preferred Attributes:

• Experience in eye hospital or OPD/IPD billing.
• Ability to handle patient queries politely and professionally.
• Ability to work under pressure during peak patient hours.

Job Types: Full-time, Permanent

Pay: ₹10,245.21 - ₹25,000.00 per month

Work Location: In person