Tpa Executive Siliguri

Key Responsibilities1. Pre-Authorization & Verification Coverage Checks: Review and validate patient insurance policies to confirm coverage eligibility for planned or emergency hospitalizations. Pre-Approval: Submit medical documents, doctor notes, and cost estimates to the insurance company/TPA to secure pre-authorization for cashless treatments. Deficiency Clearing: Promptly respond to queries and provide additional clinical information requested by the insurer to prevent authorization delays. [1, 2, 3, 4, 5] Claim Processing & Management Portal Management: Update all patient details, treatment statuses, and financial logs on the respective insurance company or TPA portals. Discharge Coordination: Guide patients through the discharge process by ensuring all clinical files, lab reports, and split bills are accurately compiled and sent for final claim approval. Reimbursement Assistance: Help patients prepare and submit necessary documents for out-of-pocket or reimbursement claims if cashless approval is denied. [1, 2, 3, 4, 5] Billing & Revenue Cycle Bill Reconciliation: Collaborate with the hospital billing and nursing teams to reconcile implant costs, pharmacy charges, and doctor fees according to insurance/corporate TPA guidelines. Denial Management: Analyze reasons for rejected or partially paid claims, and prepare appeals or resubmit corrected documents to the insurance company. [1, 2, 3] Patient & Stakeholder Communication Patient Counseling: Educate patients and their families on their insurance policy limits, co-payments, and non-medical expenses. Liaising: Maintain solid communication channels with doctors, hospital management, and external insurance representatives to ensure transparency. [1, 2, 3, 4]

Essential Skills & Qualifications Qualifications: Bachelor’s degree in Hospital Administration (BHA), Business Administration (BBA), or a related healthcare management field. Insurance Knowledge: Robust understanding of health insurance terminology, IRDAI guidelines, and TPA networks. Technical Proficiency: Experience with hospital information systems (HIS), medical billing software, and TPA portals. Soft Skills: Exceptional negotiation, conflict resolution, and communication skills to handle stressful patient queries. [1, 2, 3]

Pay: ₹15,000.91
- ₹20,000.00 per month

Perks: Provident Fund

Work Location: In person Apply on Kit Job: kitjob.in/job/4mq26f