TPA Executive

Job Summary:

The Cashless Executive is responsible for handling all processes related to cashless hospitalization, including coordination with insurance companies and TPAs, facilitating pre-authorization, and ensuring smooth admission and discharge processes for insured patients.

Key Responsibilities:

Pre-Authorization Process

• Collect necessary documents and medical details for pre-auth approval.
• Coordinate with treating doctors to prepare clinical summaries.
• Submit pre-auth requests to concerned TPAs/insurance companies.
• Follow up actively for approvals and respond to queries raised by TPAs.

Admission & Discharge Coordination

• Guide patients and relatives on the cashless process.
• Ensure approved limits are not exceeded; inform patients of any non-payable items.
• Facilitate timely final approval during discharge.
• Coordinate with the billing department to generate final bills and discharge summaries.

Documentation & Record-Keeping

• Maintain records of pre-auth forms, approvals, and correspondence.
• File and archive documents for audit and future reference.
• Ensure proper entry in the hospital information system (HIS).

TPA/Insurance Liaison

• Maintain healthy professional relations with insurance and TPA representatives.
• Stay updated with empaneled TPAs, policies, and claim requirements.

Customer Service

• Address queries and concerns of insured patients politely and professionally.
• Ensure transparency regarding inclusions, exclusions, and any out-of-pocket expenses.