This is a full-time on-site role for a TPA Executive at various branches of Sri Sai Eye Hospital / Sri Sai Lions Netralaya in Bihar The TPA Executive will be responsible for coordinating with Ayushman Bharat and third-party administrators processing insurance claims, managing patient billing, and ensuring compliance with TPA guidelines and regulations.
Key Responsibilities:
1. TPA /Insurance, CGHS, ECHS &PSus Management:
· Handle the entire process of patient admission under various TPA and insurance schemes, including documentation, eligibility checks, and obtaining pre-authorizations.
· Ensure timely submission of claims and follow up with TPAs and insurance companies for approval and settlement.
· Coordinate with patients and their families to explain the insurance process, policy coverage, and exclusions.
· Maintain and update records of all TPA, insurance transactions & Claim settlement.
2. Claims Processing:
· Review and verify insurance claims for accuracy and completeness before submission.
· Address and resolve any discrepancies or issues related to claims processing.
· Work closely with the billing department to ensure accurate billing as per insurance policies and guidelines.
3. Coordination and Communication:
· Act as a point of contact between the hospital, patients, insurance companies, and TPAs.
· Communicate effectively with all stakeholders to resolve issues related to insurance claims, approvals, and settlements.
· Provide regular updates to the management on the status of claims and any challenges encountered.
4. Reporting and Documentation:
· Prepare and maintain detailed records and reports of all insurance-related activities.
· Generate periodic reports on claim statuses, pending approvals, and settlements.
· Ensure compliance with hospital policies and insurance regulations.
5. Continuous Improvement:
· Identify opportunities for process improvement in the insurance claims process and work with the team to implement changes.
· Stay updated with the latest developments in the insurance industry, particularly related to healthcare policies