Verified Job
Lab Technician / Pharmacist
TPA Co-ordinator- job post Shri Sai Hospital
Lab Technician / Pharmacist
#815034
Remote / WFH
Shri Sai Hospital
Job Description
Full job description
We are looking for an experienced TPA Coordinator to manage and coordinate insurance/TPA-related processes, including cashless approvals, pre-authorizations, claim documentation, discharge approvals, and coordination with insurance companies and Third-Party Administrators. The candidate should have strong knowledge of hospital billing, insurance procedures, and TPA documentation.
Key Responsibilities
- Coordinate with TPAs, insurance companies, patients, doctors, billing and medical records departments.
- Handle cashless admission and pre-authorization processes.
- Prepare and submit pre-authorization requests with complete and accurate documentation.
- Follow up with TPAs/insurance companies for approval, enhancement and final authorization.
- Coordinate for cashless discharge approval and ensure timely processing.
- Verify insurance eligibility, policy details, coverage and applicable terms.
- Ensure proper collection and submission of required patient documents.
- Check medical records, investigation reports, prescriptions, bills and other documents required for claims.
- Coordinate with the billing team regarding insurance billing, deductions and claim settlements.
- Follow up on pending claims, queries, deductions and rejections.
- Maintain proper records of pre-authorizations, approvals, discharges, claims and settlements.
- Communicate professionally with patients and their attendants regarding insurance/TPA procedures.
- Resolve TPA-related queries and coordinate with concerned hospital departments for timely action.
- Ensure compliance with hospital policies, insurance guidelines and TPA requirements.
- Prepare daily/weekly/monthly TPA MIS reports and pending case reports.
- Identify documentation gaps and ensure timely correction to avoid claim delays or rejections.
- Maintain confidentiality of patient and insurance-related information.
Required Skills
- Strong knowledge of TPA, insurance and cashless hospitalization processes.
- Good understanding of hospital billing and claim documentation.
- Excellent communication and coordination skills.
- Good follow-up and problem-solving abilities.
- Proficiency in MS Office/Excel and hospital information systems (HIS).
- Ability to work under pressure and manage multiple cases simultaneously.
- Strong documentation and record-keeping skills.
- Patient-friendly and professional approach.
Eligibility
- Graduate in any discipline; preference may be given to candidates with a background in Hospital Management, Healthcare Administration, Medical Records or related fields.
- 4–5 years of relevant experience in a hospital/healthcare setup is mandatory.
- Experience in handling TPA/insurance desk, cashless approvals and hospital claims will be preferred.
Key Performance Indicators (KPIs)
- Timely processing of pre-authorization requests.
- Faster turnaround time for cashless approvals and discharge approvals.
- Reduction in pending TPA cases and claim queries.
- Accurate and complete documentation.
- Effective follow-up on pending claims and settlements.
- Reduction in claim rejection/deduction due to documentation errors.
- Patient satisfaction and effective coordination with internal departments.
Pay: ₹35,000.00 - ₹40,000.00 per month
Work Location: In person
We are looking for an experienced TPA Coordinator to manage and coordinate insurance/TPA-related processes, including cashless approvals, pre-authorizations, claim documentation, discharge approvals, and coordination with insurance companies and Third-Party Administrators. The candidate should have strong knowledge of hospital billing, insurance procedures, and TPA documentation.
Key Responsibilities
- Coordinate with TPAs, insurance companies, patients, doctors, billing and medical records departments.
- Handle cashless admission and pre-authorization processes.
- Prepare and submit pre-authorization requests with complete and accurate documentation.
- Follow up with TPAs/insurance companies for approval, enhancement and final authorization.
- Coordinate for cashless discharge approval and ensure timely processing.
- Verify insurance eligibility, policy details, coverage and applicable terms.
- Ensure proper collection and submission of required patient documents.
- Check medical records, investigation reports, prescriptions, bills and other documents required for claims.
- Coordinate with the billing team regarding insurance billing, deductions and claim settlements.
- Follow up on pending claims, queries, deductions and rejections.
- Maintain proper records of pre-authorizations, approvals, discharges, claims and settlements.
- Communicate professionally with patients and their attendants regarding insurance/TPA procedures.
- Resolve TPA-related queries and coordinate with concerned hospital departments for timely action.
- Ensure compliance with hospital policies, insurance guidelines and TPA requirements.
- Prepare daily/weekly/monthly TPA MIS reports and pending case reports.
- Identify documentation gaps and ensure timely correction to avoid claim delays or rejections.
- Maintain confidentiality of patient and insurance-related information.
Required Skills
- Strong knowledge of TPA, insurance and cashless hospitalization processes.
- Good understanding of hospital billing and claim documentation.
- Excellent communication and coordination skills.
- Good follow-up and problem-solving abilities.
- Proficiency in MS Office/Excel and hospital information systems (HIS).
- Ability to work under pressure and manage multiple cases simultaneously.
- Strong documentation and record-keeping skills.
- Patient-friendly and professional approach.
Eligibility
- Graduate in any discipline; preference may be given to candidates with a background in Hospital Management, Healthcare Administration, Medical Records or related fields.
- 4–5 years of relevant experience in a hospital/healthcare setup is mandatory.
- Experience in handling TPA/insurance desk, cashless approvals and hospital claims will be preferred.
Key Performance Indicators (KPIs)
- Timely processing of pre-authorization requests.
- Faster turnaround time for cashless approvals and discharge approvals.
- Reduction in pending TPA cases and claim queries.
- Accurate and complete documentation.
- Effective follow-up on pending claims and settlements.
- Reduction in claim rejection/deduction due to documentation errors.
- Patient satisfaction and effective coordination with internal departments.
Pay: ₹35,000.00 - ₹40,000.00 per month
Work Location: In person
