TPA Executive

Department: Billing / Finance / TPA
Reports To: TPA Manager / Billing Head / Hospital Administrator
Employment Type: Full-time

Job Summary:

The TPA (Third Party Administrator) Executive is responsible for coordinating and managing all aspects related to cashless insurance and TPA billing operations in the hospital. This includes pre-authorization, insurance documentation, claim submissions, and following up with TPAs/insurance companies to ensure timely settlement of claims.

Key Responsibilities:

• Pre-Authorization & Admission Process:
• Coordinate with the treating doctor to obtain necessary medical information for pre-authorization.
• Submit pre-authorization requests to the respective TPAs/insurance companies.
• Follow up for approval and inform patients/attendants accordingly.
• Insurance Documentation:
• Collect and verify insurance documents from patients at the time of admission.
• Ensure all required forms (insurance card, ID proof, policy documents, etc.) are accurately filed.
• Claim Management:
• Prepare and submit claims to TPAs/insurance companies with proper documentation.
• Monitor claim status and follow up for pending payments or rejections.
• Handle queries and rejections, resubmit claims as needed.
• Discharge Process:
• Coordinate with medical, nursing, and billing teams to prepare final bill.
• Submit final bill to the TPA for final approval before discharge.
• Ensure timely issuance of discharge summary and final bill approval.
• Coordination & Communication:
• Maintain effective communication with patients, insurance companies, TPAs, and internal departments.
• Explain insurance policies and billing procedures to patients.
• Reporting & Documentation:
• Maintain daily reports of admissions, approvals, discharges, and claim submissions.
• Maintain up-to-date records of insurance companies and TPA contacts.
• Ensure compliance with internal hospital policies and insurance norms.

Key Skills & Competencies:

• Knowledge of health insurance policies and TPA processes
• Good communication and interpersonal skills
• Attention to detail and accuracy
• Time management and ability to handle pressure
• Proficiency in MS Office and hospital billing software (HIS)

Educational Qualifications:

• Bachelor's degree in any discipline (Commerce, Healthcare Administration preferred)
• Certification or training in medical billing/TPA management is an advantage

Experience:

• Minimum 1-3 years of experience in TPA operations or hospital billing
• Experience in working with multiple insurance providers and TPAs

Job Types: Full-time, Permanent

Pay: ₹20,000.00 - ₹35,000.00 per month

Work Location: In person