TPA Executive

Role Overview

As a TPA Desk Executive, you are the vital link between the hospital, the insurance companies (TPAs), and the patients. Your mission is to ensure that the financial side of healthcare is as painless as possible for our patients while maintaining meticulous records for the hospital. You'll handle everything from pre-authorizations to final billing, with a side of front-desk flair when things get busy.

Key Responsibilities

1. TPA & Insurance Coordination

• Pre-Authorization: Facilitate the initial "cashless" request by gathering medical documents and submitting them to TPAs/Insurance companies promptly.
• Claim Management: Follow up on pending claims, resolve queries raised by insurance doctors, and ensure the hospital receives timely approvals.
• Patient Counseling: Explain insurance coverage, co-payments, and exclusions to patients and their families so there are no "surprise" costs at discharge.

2. Billing & Data Entry

• Accurate Billing: Prepare final discharge bills by ensuring all pharmacy, lab, and surgery charges are correctly entered into the Hospital Information System (HIS).
• Data Integrity: Maintain an error-free database of patient records, insurance IDs, and claim statuses.
• Discharge Formalities: Coordinate with the nursing stations and doctors to ensure the billing process doesn't delay the patient’s journey home.

3. Front Office & Reception Support

• The "First Impression": Assist at the reception desk during peak hours—greeting patients and directing them to the correct departments.
• Communication Hub: Answer incoming calls regarding insurance queries, room availability, or general hospital information.
• Conflict Resolution: Calmly handle frustrated patients or insurance delays with empathy and professionalism.
• Required Skills & QualificationsEducation: Graduate in any stream (Commerce or Healthcare Administration preferred).
• Experience: 1–3 years in a hospital TPA/Billing department. Familiarity with IRDAI guidelines and standard medical coding is a huge plus.
• Tech Savvy: High speed and accuracy in data entry. Comfort with HIS software and MS Excel.
• The "Soft" Stuff: * Excellent communication (multilingual is a bonus).

• The patience of a saint when dealing with insurance call centers.
• A sharp eye for detail—missing one decimal point can be a big headache.