Manager /Deputy Manager – TPA (JD-0089)

Sant Nirankari Health City; Dublin; Sur place; EUR 40 000 - 60 000; Plein temps

Résumé du poste

Sant Nirankari Health City is seeking a skilled TPA/insurance administration professional to manage cashless and insurance patient workflows from admission to discharge.

You will coordinate with patients, attendants, doctors, nursing staff, and TPAs, preparing pre-authorization and handling follow-ups to ensure timely approvals and accurate documentation.

Qualifications

• Graduate preferably in Healthcare/Hospital Management.
• Minimum 5-6 years of experience in hospital TPA/insurance, preferably in a multi-specialty hospital.

Responsabilités

• Handle cashless and insurance patients efficiently from admission to discharge.
• Coordinate with patients, attendants, doctors, nursing staff, and insurance/TPA companies.
• Prepare and submit pre-authorization requests with accurate clinical and billing documents.
• Follow up with TPAs/insurance companies for approvals, enhancements, and query resolutions.
• Process approval enhancement requests based on treatment progress and revised estimates.
• Ensure timely final discharge approval and coordinate smooth patient discharge.
• Reply to TPA/insurance queries and arrange required medical documents within TAT.
• Verify patient insurance eligibility, policy coverage, exclusions, and corporate tie-ups.
• Maintain proper documentation of approvals, denials, claims, and correspondence.
• Coordinate with billing team for accurate package billing and claim preparation.
• Minimize claim rejections and delays through proper documentation and follow up.
• Maintain daily MIS/reports related to approvals, pending cases, discharges, and denials.
• Ensure compliance with hospital policies, insurance guidelines, and NABH requirements.

Connaissances

TPA processes

Hospital billing

Communication

Coordination

Documentation

MS Office

HIS

Formation

Graduate in Healthcare/Hospital Management

Outils

HIS

MS Office

Description du poste

Key Responsibilities

• Handle cashless and insurance patients efficiently from admission to discharge.
• Coordinate with patients, attendants, doctors, nursing staff, and insurance/TPA companies.
• Prepare and submit pre-authorization requests with accurate clinical and billing documents.
• Follow up with TPAs/insurance companies for approvals, enhancements, and query resolutions.
• Process approval enhancement requests based on treatment progress and revised estimates.
• Ensure timely final discharge approval and coordinate smooth patient discharge.
• Reply to TPA/insurance queries and arrange required medical documents within TAT.
• Verify patient insurance eligibility, policy coverage, exclusions, and corporate tie-ups.
• Maintain proper documentation of approvals, denials, claims, and correspondence.
• Coordinate with billing team for accurate package billing and claim preparation.
• Minimize claim rejections and delays through proper documentation and follow up.
• Maintain daily MIS/reports related to approvals, pending cases, discharges, and denials.
• Ensure compliance with hospital policies, insurance guidelines, and NABH requirements.

Key Responsibilities

• Handle cashless and insurance patients efficiently from admission to discharge.
• Coordinate with patients, attendants, doctors, nursing staff, and insurance/TPA companies.
• Prepare and submit pre-authorization requests with accurate clinical and billing documents.
• Follow up with TPAs/insurance companies for approvals, enhancements, and query resolutions.
• Process approval enhancement requests based on treatment progress and revised estimates.
• Ensure timely final discharge approval and coordinate smooth patient discharge.
• Reply to TPA/insurance queries and arrange required medical documents within TAT.
• Verify patient insurance eligibility, policy coverage, exclusions, and corporate tie-ups.
• Maintain proper documentation of approvals, denials, claims, and correspondence.
• Coordinate with billing team for accurate package billing and claim preparation.
• Minimize claim rejections and delays through proper documentation and follow up.
• Maintain daily MIS/reports related to approvals, pending cases, discharges, and denials.
• Ensure compliance with hospital policies, insurance guidelines, and NABH requirements.

Required Skills

• Good knowledge of TPA/insurance processes and hospital billing.
• Strong communication and coordination skills.
• Ability to handle patients and insurance coordinators professionally.
• Knowledge of HIS and MS Office preferred.
• Good follow-up and documentation skills.

Qualification & Experience

• Graduate preferably in Healthcare/Hospital Management.
• Minimum 5-6 years of experience in hospital TPA/insurance, preferably in multi-specialty hospital.

Remuneration: As per industry standards

Why Join Us

At Sant Nirankari Health City, we offer a collaborative and supportive work environment where your contributions are valued and recognized. Join us in our mission to deliver exceptional healthcare services while upholding the highest standards of quality and patient care.