TPA Coordinator

TPA Coordinator

Location: Hospital (Kalyan West)

Qualification: Graduate (B.Com / BBA / Any discipline)

Experience: 1–3 Years (Experience in hospital TPA desk preferred)

Handle pre-authorizations, approvals, and insurance claim submissions.

Verify patient insurance details and maintain proper documentation.

Coordinate with doctors, billing, and TPAs for claim processing.

Prepare MIS reports and assist patients with insurance queries.

Key functions of the hospital TPA desk

• Claim processing: The primary function is to process and manage health insurance claims, whether they are for cashless treatment or reimbursement. 
• Cashless authorization: TPAs are responsible for getting pre-authorization from the insurance company for cashless medical procedures. 
• Reimbursement support: For claims that require reimbursement, the TPA will review the documents and forward the claim to the insurer for settlement. 
• Policy validation: The desk verifies if the patient's medical policy covers the specific treatment being received and informs the patient of any out-of-pocket expenses. 
• Patient guidance: It serves as a point of contact for insurance-related questions, providing information on procedures, exclusions, and inclusions in the policy. 
• Member services: This can include helping with member enrollment and issuing health cards.