Coordinate with TPA companies and insurance providers for patient admissions, approvals, extensions, and final settlement.
Verify and process cashless requests for insured patients.
Maintain proper documentation for all TPA cases, including pre-authorization, enhancement, and discharge approvals.
Follow up with TPA/Insurance companies for timely settlement of claims.
Ensure compliance with all TPA/Insurance guidelines and hospital policies.
Maintain records of TPA claim submissions and reconciliations.
Resolve queries raised by patients, TPAs, or internal departments.
Prepare and generate patient bills (IPD/OPD) accurately on time.
Handle billing of all cash, card, TPA, insurance, corporate, and credit cases.
Ensure correct entry of services, procedures, pharmacy, investigations, and consultant charges in the billing system.
Collect and verify deposits, advance payments, and outstanding balances.
Maintain accuracy in discharge billing and coordinate with wards/nursing staff for final bill clearance.
Coordinate with internal departments (pharmacy, pathology, radiology, etc.) to ensure proper charge capturing.
Submit daily billing and collection reports to management.
Knowledge of hospital billing procedures, TPA process, and insurance claims.
Good communication & coordination skills.
Strong documentation and record-keeping abilities.
Proficiency in hospital billing software and MS Excel.
Attention to detail and accuracy.
Ability to handle patients and attendants politely during billing/TPA process.
Graduate (Commerce/Management/Healthcare preferred).
Diploma/Certificate in Hospital Administration, Medical Billing, or TPA coordination preferred.
Experience: 2–5 years in hospital billing & TPA operations.