Job Description

Job Title: TPA Executive

Job Location: Eye Mantra Hospital, Pachim VIhar, Delhi
Reports To: TPA Manager / Billing and Insurance Manager

Key Responsibilities:

• Insurance Verification and Authorization:
• Verify patient insurance details and eligibility at the time of admission or prior to medical procedures.
• Liaise with the respective TPAs and insurance providers to obtain pre-authorization and pre-certification for medical services.
• Ensure that all necessary documentation, including patient medical records and treatment plans, are provided for pre-authorization and claims processing.
• Claims Management:
• Process and follow up on insurance claims, ensuring that claims are submitted accurately and in a timely manner.
• Coordinate with the insurance companies and TPAs for claim settlement, follow-up, and reimbursement.
• Resolve any discrepancies or issues related to claims, including incomplete documentation or disputes.
• Documentation and Record Keeping:
• Maintain accurate and up-to-date records of insurance policies, claim submissions, authorizations, and rejections.
• Ensure that all patient insurance-related documents are organized and readily accessible for audits and reviews.
• Keep a detailed log of all TPA interactions, including calls, emails, approvals, and claim status updates.
• Patient Interaction and Assistance:
• Communicate with patients to inform them about insurance coverage and the documentation required for TPA processing.
• Assist patients in understanding their insurance policies, benefits, and any out-of-pocket expenses that they may incur.
• Act as a point of contact for patients to resolve any concerns or queries related to TPA or insurance claims.

Skills and Qualifications:

• Experience:
• Minimum 1-3 years of experience in handling TPA or insurance-related activities in a healthcare setting, preferably in an ophthalmology or multi-specialty hospital.
• Prior experience in medical billing, insurance verification, and claim management is a plus.
• Education:
• Bachelor's degree in any stream (preferably healthcare administration, insurance, or medical billing).
• Certification or training in medical billing or healthcare management is a plus.
• Skills:
• Knowledge of insurance processes, claim submissions, and pre-authorization procedures.
• Familiarity with TPA systems, healthcare billing software, and insurance-related documentation.
• Strong organizational and time-management skills.
• Excellent communication skills (both written and verbal) to interact with insurance providers, patients, and hospital departments.
• Attention to detail and ability to handle sensitive information in a confidential manner.
• Ability to handle multiple tasks and manage deadlines effectively.

Job Type: Full-time

Pay: ?15,000.00 - ?25,000.00 per month

Schedule:

• Day shift

Experience:

• total work: 1 year (Preferred)

Work Location: In person