Billing Operator

About the Role  

We are looking for a detail-oriented and experienced Hospital Billing Operator to manage cashless insurance billing through TPAs. The ideal candidate should be well-versed with medical billing codes, insurance claim processes, and must be proficient in Excel for reporting and reconciliation.

Key Responsibilities  

- Process cashless insurance claims for IPD/OPD patients via TPA portals  

- Coordinate with TPA desk, insurance companies, and patients for approvals, queries, and denials  

- Verify patient eligibility, coverage, and pre-authorization requirements before billing  

- Generate final bills, raise claims, and ensure timely submission to TPAs/insurers  

- Follow up on pending claims, handle rejections, and initiate re-submissions with required documents  

- Maintain daily billing MIS, claim tracking sheets, and aging reports using advanced Excel features  

- Reconcile payments received from TPAs against raised claims and highlight discrepancies

- Coordinate with doctors, nursing staff, and medical records for case sheets, discharge summaries, and query resolution  

Requirements  

- Minimum 2 years of experience in hospital billing with exposure to cashless TPA claims  

- Strong knowledge of medical billing codes: ICD-10, CPT, HCPCS, and TPA tariff mapping  

- Hands-on experience with TPA portals like Medi Assist, FHPL, Vidal, Paramount, etc.  

- Proficiency in MS Excel: VLOOKUP, Pivot Tables, Filters, Formulas, and Data Validation  

- Good understanding of claim lifecycle – pre-auth to final settlement  

- Excellent communication and coordination skills with TPAs and insurance desks 

- Diploma in Medical Billing/Healthcare Management is a plus

Candidates should whatsapp their resume