Incharge - TPA (Doctor)

K.J. Somaiya Hospital & Research Centre; Mumbai; On-site; INR 1,200,000 - 1,800,000; Full time

Benefits offered by this job

Lead TPA department

Structured working environment

Salary as per hospital norms

Job summary

K.J. Somaiya Hospital & Research Centre in Sion, Mumbai invites applications for the Incharge - TPA to lead its TPA, MJPJAY and Corporate billing. The role emphasizes SOPs, empanelment, negotiations and end-to-end TPA workflow with focus on timely claims and cashless processes.

The incumbent will supervise billing, ensure timely submissions, guide cashless settlements, and train staff across departments. Immediate joiners preferred.

Qualifications

• Medical degree (MBBS / BAMS / BHMS) is mandatory.
• Valid Maharashtra council registration is required.
• Experience in handling TPA, MJPJAY and corporate billing in a hospital setup is essential.
• Strong knowledge of cashless and reimbursement processes and TPA portals.
• Good understanding of hospital billing and MOU terms.
• Negotiation, liaison and team leadership skills.
• Proficiency in MS Excel and hospital software.

Responsibilities

• Prepare and implement SOPs for smooth functioning of the TPA department
• Handle empanelment of TPAs, MJPJAY and Corporates and ensure renewal of MOUs within TAT
• Negotiate best rates and discounts with TPAs, MJPJAY and Corporates
• Oversee daily admissions, discharges, TPA queries, claims, reimbursements and outstanding payments
• Supervise accurate billing of TPA, MJPJAY and Corporate patients as per MOU terms
• Verify pre-authorisation and final approval letters
• Cross-check final bills and discharge summaries before submission to TPAs
• Ensure complete claim files are sent to TPA, MJPJAY and Corporates within timelines
• Ensure recovery of payments within TAT and follow up on delayed or pending payments, including visits to TPA offices when required
• Ensure payment settlements are updated in the system within TAT
• Coordinate with patients, consultants and management for CABG package billing
• Guide patients and relatives on deductions and ensure settlement for cashless cases
• Resolve patient grievances and reimbursement claim queries
• Conduct regular training for departmental staff
• Prepare and submit monthly MIS reports to management
• Coordinate with other departments for smooth functioning

Skills

Negotiation

Leadership

Team coordination

Communication

Education

MBBS / BAMS / BHMS

Valid Maharashtra council registration

Tools

MS Excel

Hospital software

Job description

K.J. Somaiya Hospital & Research Centre, a 550-bedded medical college and hospital in Sion, Mumbai, is hiring an Incharge - TPA to lead its TPA, MJPJAY and Corporate department.

Roles and Responsibilities

• Prepare and implement SOPs for smooth functioning of the TPA department
• Handle empanelment of TPAs, MJPJAY and Corporates and ensure renewal of MOUs within TAT
• Negotiate best rates and discounts with TPAs, MJPJAY and Corporates
• Oversee daily admissions, discharges, TPA queries, claims, reimbursements and outstanding payments
• Supervise accurate billing of TPA, MJPJAY and Corporate patients as per MOU terms
• Verify pre-authorisation and final approval letters
• Cross-check final bills and discharge summaries before submission to TPAs
• Ensure complete claim files are sent to TPA, MJPJAY and Corporates within timelines
• Ensure recovery of payments within TAT and follow up on delayed or pending payments, including visits to TPA offices when required
• Ensure payment settlements are updated in the system within TAT
• Coordinate with patients, consultants and management for CABG package billing
• Guide patients and relatives on deductions and ensure settlement for cashless cases
• Resolve patient grievances and reimbursement claim queries
• Conduct regular training for departmental staff
• Prepare and submit monthly MIS reports to management
• Coordinate with other departments for smooth functioning

Desired Candidate Profile

• Medical graduate (MBBS / BAMS / BHMS) is mandatory
• Valid registration with the respective Maharashtra council
• Experience in handling TPA, MJPJAY and corporate billing in a hospital setup
• Strong knowledge of cashless and reimbursement processes and TPA portals
• Good understanding of medical terminology, hospital billing and MOU terms
• Negotiation, liaison and team leadership skills
• Good command of MS Excel and hospital software

Perks and Benefits

• Opportunity to lead the TPA department of a 550-bedded medical college and hospital
• Structured working environment with exposure to TPA, MJPJAY and corporate accounts
• Salary as per qualification and hospital norms

The roles and responsibilities mentioned above are indicative and may be modified from time to time as per organisational requirements.

* Immediate joiners or candidates with a short notice period will be preferred