Key Responsibilities
Claims Processing:
Verifying, processing, and facilitating the approval and settlement of both cashless and reimbursement claims.
Patient & Provider Coordination:
Acting as the primary point of contact for insurance-related matters, coordinating with patients and hospital departments from admission to discharge.
Billing & Documentation:
Preparing and reconciling bills, including managing implant bills and doctor charges, and ensuring all documents comply with policy terms.
TPA Portal & Compliance:
Handling and uploading documents to TPA portals and ensuring adherence to all insurance regulations and guidelines.
Customer Service:
Providing exceptional customer service to patients by addressing their queries, explaining policy coverage, and assisting with pre-authorization processes.
Reporting:
Generating reports on claims processing and status for internal review and analysis.
Panel Management:
Assisting in onboarding and maintaining relationships with different insurance panels and corporates.
Required Skills and Qualifications
Education:
A Bachelor's degree in any discipline is generally required. Degrees in Healthcare Administration, Insurance, or Healthcare Management are preferred.
Experience:
Previous experience in the TPA department of a hospital, in healthcare insurance, or with hospital billing systems is highly valuable.
Technical Proficiency:
Familiarity with TPA software, hospital information systems (HIS), and MS Excel is necessary.
Soft Skills:
Strong communication, customer service, and negotiation skills are essential for interacting with diverse stakeholders.
Knowledge:
A thorough understanding of healthcare policies, insurance regulations, and claims processing protocols is critical.