TPA Billing Executive

Drlogy; Ahmedabad District; On-site; INR 300,000 - 500,000; Full time

Job summary

Drlogy is seeking a TPA Billing Executive in Ahmedabad, Gujarat, to manage TPA billing, insurance documentation, and claims processing. The role demands a graduate with 5-7 years of experience and a comprehensive understanding of TPA processes.

The selected candidate will coordinate with healthcare professionals and insurance companies to ensure efficient claim handling, maintain documentation standards, and support discharge billing while adhering to compliance requirements.

Qualifications

• 5-7 years of experience handling TPA billing and cashless claim processing.
• Strong knowledge of insurance documentation and claim coordination.
• Ability to maintain confidentiality of financial information.

Responsibilities

• Handle TPA, mediclaim, cashless, insurance, and corporate billing processes.
• Verify patient insurance documents and eligibility requirements.
• Prepare and submit pre-authorization forms and billing documents.
• Coordinate with doctors and insurance companies for claim processing.
• Maintain TPA files and claim records as per hospital SOPs.

Skills

TPA processes

Billing accuracy

Documentation discipline

Coordination skills

Education

Graduate or relevant qualification

Job description

The TPA Billing Executive will be responsible for handling TPA billing, insurance documentation, cashless claim processing, pre-authorization support, claim coordination, and discharge billing at Sahadev Hospital, Ahmedabad. This requires a graduate or relevant qualification with 5-7 years of experience, strong knowledge of TPA processes, billing accuracy, documentation discipline, and coordination skills.

• Handle TPA, mediclaim, cashless, insurance, and corporate billing processes.
• Verify patient insurance documents, policy details, proof, and eligibility requirements.
• Prepare and submit pre-authorization forms, medical papers, billing documents, and claim files.
• Coordinate with doctors, billing, MRD, nursing, patients, attendants, and insurance companies.
• Track approvals, enhancements, query replies, denials, final approvals, and discharge clearance.
• Ensure diagnosis, treatment notes, investigation reports, and billing details are properly documented.
• Explain insurance process, required documents, approvals, and payment responsibilities to patients.
• Maintain TPA files, claim records, approval letters, query responses, and daily trackers.
• Follow up with TPA companies for pending approvals and claim settlement updates.
• Support discharge billing by coordinating final authorization and payment clearance.
• Identify claim errors, documentation gaps, or rejected cases and elevate to seniors.
• Maintain confidentiality of patient, insurance, billing, and financial information.
• Prepare MIS reports related to cashless cases, pending claims, approvals, and rejections.
• Follow hospital TPA billing SOPs, documentation standards, and compliance requirements.
• Ensure smooth, timely, and patient-friendly insurance billing support.