HEAD - TPA & Billing

Criticare Asia Multispeciality Hospital; Mumbai Suburban; On-site; INR 240,000 - 420,000; Full time

Job summary

Criticare Asia Multispeciality Hospital in Mumbai is seeking a TPA Coordinator for the Hospital Billing Department. You will verify patient insurance/TPA details at admission, collect documents, and submit cashless pre-authorization requests while communicating approvals or queries to patients and departments.

You will manage billing documentation, prepare final bills per tariff, process cashless approvals, assist with reimbursements, and coordinate discharge with doctors and billing teams to

Responsibilities

• Verify patient insurance/TPA details at admission and collect required documents; submit cashless pre-authorization requests to the TPA; communicate approvals, denials, or queries from the TPA to patients and departments; ensure timely follow-up on pending pre-auth approvals.
• Act as the primary contact between the hospital and TPAs/insurance companies; respond promptly to TPA queries related to treatments, packages, and lines of treatment; maintain healthy relationships with TPA representatives.
• Ensure all medical records, treatment notes, investigation reports, and bills are accurate and complete; prepare final bills for insured patients as per TPA tariff and agreements; check admissibility of charges based on TPA policies.
• Process cashless discharge approvals by sending final bill and discharge summary to TPA; assist patients in documentation for reimbursement claims; ensure all claim forms are properly filled, signed, and stamped.
• Coordinate with doctors, nurses, and billing team to prepare discharge summary and documentation; follow up with TPA for final authorization to avoid discharge delays; communicate approved and non-approved items to patients clearly.
• Submit completed claims to TPA within timelines; track and follow up on claim status to avoid rejections and delays; re-submit additional documents or justifications requested by TPA.
• Handle claim rejections, short-settlements, and TPA queries professionally; coordinate with medical team to provide clarifications or additional documents; maintain records of denials and initiate corrective actions.

Job description

Job Responsibilities of a TPA Coordinator (Hospital Billing Department)

1. Patient Admission & Pre-Authorization

• Verify patient insurance/TPA details at the time of admission.
• Collect required documents and submit cashless pre-authorization requests to the respective TPA.
• Communicate approvals, denials, or queries from TPA to patients and concerned departments.
• Ensure timely follow-up on pending pre-auth approvals.

2. Coordination With TPA / Insurance Companies

• Act as the primary point of contact between the hospital and TPAs/insurance companies.
• Respond promptly to TPA queries related to patient treatments, packages, line of treatment, etc.
• Maintain healthy working relationships with TPA representatives.

3. Billing & Documentation

• Ensure all medical records, treatment notes, investigation reports, and bills are accurate and complete.
• Prepare final bills for insured patients as per TPA tariff and agreements.
• Check admissibility of charges based on TPA policies and guidelines.

4. Cashless & Reimbursement Processing

• Process cashless discharge approvals by sending final bill and discharge summary to TPA.
• Assist patients in documentation for reimbursement claims.
• Ensure all claim forms are correctly filled, signed, and stamped.

5. Discharge Coordination

• Coordinate with doctors, nurses, and billing team to prepare discharge summary and documentation.
• Follow up with TPA for final authorization to avoid discharge delays.
• Communicate approved and non-approved items to patients clearly.

6. Claim Submission & Follow-Up

• Submit completed claims to TPA within timelines.
• Track and follow up on claim status to avoid rejections and delays.
• Re-submit additional documents or justifications requested by TPA.

7. Denial & Query Management

• Handle claim rejections, short-settlements, and TPA queries professionally.
• Coordinate with medical team to provide clarifications or additional documents.
• Maintain records of denials and initiate corrective actions.

Contact person : Human Resources

Contact Number : 9930400992

Email Address : [e-mail]