TPA Doctor

Sarvodaya Hospital; Greater Noida; On-site; INR 350,000 - 550,000; Full time

Job summary

Sarvodaya Hospital is seeking a dedicated professional to review patient records and determine medical necessity for TPA/insurance cases. You will coordinate with consultants, nursing, billing, and other departments to gather required documents and ensure timely submission to TPAs.

Adherence to confidentiality and compliance is essential. The role involves handling pre-authorizations, discharge approvals, and TPA queries, with regular office rounds to follow up on pending cases.

Qualifications

• Review patient records and assess medical necessity for TPA/insurance cases.
• Coordinate with clinical departments to gather required documents and approvals.
• Maintain TPA records, MIS, and patient confidentiality.

Responsibilities

• Handle pre-authorizations, enhancements, discharge approvals, and TPA queries.
• Ensure timely and accurate submission of medical documents to TPAs/insurance companies.
• Follow up on pending approvals and resolve documentation/medical queries.
• Conduct regular CMO office rounds for follow-up of pending TPA cases and documentation.

Skills

Billing accuracy

Patient handling

Problem solving

Coordination with clinical departments

Time management

Job description

Job Description

• Review patient records and assess medical necessity for TPA/insurance cases.
• Handlepre-authorizations, enhancements, discharge approvals, and TPA queries.
• Coordinate with consultants, nursing, billing, MRD, and other departments for required documents.
• Ensure timely and accurate submission of medical documents to TPAs/insurance companies.
• Follow up on pending approvals and resolve documentation/medical queries.
• Conductregular CMO office roundsfor follow-up of pending TPA cases and documentation.
• Maintain TPA records, MIS, and confidentiality of patient information.
• Support claim audits and ensure compliance with hospital/TPA guidelines.

Key Skills

• Billing accuracy Patient handling Problem solving Coordination with clinical departments Time management