Job Description

• Insurance Liaison : Acting as a bridge between the hospital, patients, and insurance companies, you facilitate the processing of insurance claims, verify patient coverage, and coordinate billing and reimbursement processes.
• Claims Processing : Your team is responsible for accurately processing and adjudicating insurance claims submitted by healthcare providers within the hospital. This involves verifying the accuracy of medical codes, ensuring compliance with insurance policies, and resolving any discrepancies or issues that may arise during the claims process.
• Provider Network Management : TPA hospitals often have agreements with a network of healthcare providers. You are responsible for managing these provider networks, negotiating contracts, and ensuring that the network meets the needs of patients while maintaining cost-effectiveness for the hospital.
• Patient Assistance and Support : Providing assistance to patients in understanding their insurance coverage, explaining billing procedures, and addressing any concerns or questions they may have regarding their healthcare expenses.
• Compliance and Regulatory Requirements : Staying up-to-date with healthcare regulations, including HIPAA and other relevant laws, and ensuring that the hospital's operations comply with these regulations. This includes maintaining patient confidentiality and protecting sensitive medical information.
• Data Management and Analysis : Collecting, analyzing, and reporting data related to claims processing, reimbursement rates, provider performance, and other relevant metrics. This data-driven approach helps identify areas for improvement and optimize processes to enhance efficiency and quality of care.
• Customer Service : Providing excellent customer service to both patients and healthcare providers, promptly addressing inquiries, resolving issues, and maintaining positive relationships to foster trust and satisfaction.
• Cost Containment Strategies : Implementing strategies to control healthcare costs while maintaining high-quality care. This may involve negotiating favorable rates with providers, implementing utilization management programs, and identifying opportunities for cost savings without compromising patient care.
• Quality Assurance : Monitoring the quality of healthcare services provided within the hospital, ensuring that they meet established standards of care, and implementing measures to continuously improve quality and patient outcomes.
• Technology Integration : Leveraging technology solutions, such as healthcare management software and electronic health records systems, to streamline processes, enhance efficiency, and improve communication among stakeholders.

As a Third-Party Administrator (TPA) for a hospital as your role.....

Job Types: Full-time, Permanent

Pay: ?20,000.00 - ?45,000.00 per month

Benefits:

• Cell phone reimbursement
• Provident Fund

Schedule:

• Day shift
• Fixed shift
• Morning shift

Supplemental Pay:

• Yearly bonus

Experience:

• total work TPA BILLING IN HOSPITAL: 2 years (Preferred)
• all the claim bills settle in timely: 1 year (Preferred)

Work Location: In person