Accounts Billing And TPA Executive

Job Summary

We are looking for a detail-oriented and responsible Billing & TPA Executive to manage hospital billing operations, insurance and cashless patient coordination, TPA documentation, and claim processing. The candidate will be responsible for ensuring accurate billing, timely submission of insurance claims, and smooth coordination between patients, doctors, hospital departments, and insurance companies.

Key Responsibilities

1. Hospital Billing

• Prepare and process accurate patient bills for IPD, OPD, and emergency cases.

• Handle cash, credit, insurance, and corporate patient billing.

• Verify billing entries, service charges, pharmacy bills, and investigation charges.

• Ensure timely preparation of final bills and discharge billing.

• Coordinate with the concerned departments for billing clarifications and corrections.

• Maintain daily billing records and reports.

2. TPA & Insurance Operations

• Handle cashless and reimbursement insurance cases.

• Coordinate with TPAs and insurance companies for pre-authorisation and claim approvals.

• Prepare, verify, and submit insurance documents within stipulated timelines.

• Follow up on pending pre-authorisations, query resolutions, and claim settlements.

• Coordinate with doctors for medical records, treatment summaries, and necessary clinical documents.

• Ensure proper documentation for claim submission and discharge approvals.

• Maintain records of approved, rejected, pending, and settled claims.

3. Patient Coordination

• Explain billing procedures, insurance coverage, and estimated expenses to patients and attendants.

• Coordinate with patients and their families regarding deposits, advances, and outstanding payments.

• Ensure timely collection of advances and final payments.

• Assist patients during admission and discharge formalities.

4. Documentation & Reporting

• Maintain proper records of patient billing and insurance documentation.

• Prepare daily, weekly, and monthly billing and TPA reports.

• Track pending claims, outstanding payments, and insurance queries.

• Ensure compliance with hospital policies and applicable documentation requirements.

• Maintain confidentiality of patient and financial information.

Required Skills & Qualifications

• Graduate in any discipline; preferably B.Com, BBA, or healthcare management.

• 1–3 years of experience in hospital billing and TPA operations.

• Knowledge of cashless insurance processes and medical billing.

• Familiarity with major insurance companies and TPAs.

• Good communication and coordination skills.

• Basic computer knowledge, MS Excel, and hospital management software.

• Strong attention to detail and problem-solving abilities.

• Ability to work under pressure and manage multiple responsibilities.

Key Performance Indicators (KPIs)

• Accuracy in patient billing and financial entries.

• Timely submission and processing of insurance claims.

• Reduction in claim rejections and documentation errors.

• Timely follow-up on pending insurance approvals and claims.

• Proper collection of patient advances and outstanding payments.

• Patient satisfaction and coordination with internal departments.

• It is a Full Time Accountant job for candidates with 2 - 6 years of experience.