Accounts Billing And TPA Executive

Third Party Administrator (TPA)

About our Hospital

Sat Kartar Sanjeevan Hospital is a NABH Accredited Ayurvedic Hospital dedicated to providing evidence-based, patient-centric Ayurvedic healthcare. Backed by the trusted Sat Kartar legacy since 2012, the hospital specializes in the management of chronic lifestyle disorders through personalized Ayurvedic treatments, Panchakarma therapies, Shalya Tantra, Naturopathy, and holistic wellness programs. The hospital is committed to maintaining the highest standards of patient safety, quality care, and ethical medical practices.

Position Details Role:

1. Third Party Administrator (TPA)

2. Office Locations: Paschim Vihar, Delhi

3. Duty Timings: 9:00 AM - 6:00 PM

Job Description

We are looking for a detail-oriented TPA Executive to manage cashless insurance and reimbursement processes, coordinate with Third Party Administrators (TPAs), insurance companies, and the CGHS desk, and ensure timely claim processing while delivering a seamless patient experience.

Key Responsibilities

1. Process cashless hospitalization and reimbursement claims.

2. Coordinate with TPAs, insurance companies, and CGHS authorities for pre-authorizations and claim approvals.

3. Verify patient insurance eligibility, policy coverage, and required documentation.

4. Prepare and submit pre-authorization requests, claim forms, and supporting medical documents.

5. Follow up on pending approvals, claim settlements, and reimbursement cases.

6. Coordinate with doctors, nursing, billing, medical records, and front office teams for claim related documentation.

7. Ensure accurate documentation as per TPA, CGHS, and NABH guidelines.

8. Resolve claim queries, discrepancies, deductions, and rejections within the stipulated timelines.

9. Maintain records of claims, approvals, settlements, and pending cases.

10. Ensure compliance with hospital policies, NABH standards, and insurance regulations.

11. Assist patients in understanding insurance procedures and provide timely updates on claim status.

Requirements

1. Experience: 2–5 years of relevant experience in TPA operations, medical insurance claims, or hospital billing.

2. Experience in handling cashless hospitalization and reimbursement claims is mandatory.

3. Knowledge of CGHS claim processing and NABH documentation standards will be preferred.

4. Proficiency in MS Office and Hospital Information Systems (HIS).

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