The TPA Coordinator is responsible for the complete management of cashless insurance, corporate, government health schemes, and reimbursement cases. The role ensures timely pre-authorizations, accurate documentation, effective coordination with insurance companies and TPAs, prompt claim settlements, and an excellent patient experience throughout the hospitalization.
The coordinator acts as the bridge between patients, doctors, nursing, billing, insurance companies, TPAs, and internal hospital departments.
Key Responsibilities
1. Cashless Admission Management
- Verify patient's insurance eligibility.
- Check policy coverage and exclusions.
- Explain cashless process to patients and relatives.
- Coordinate with admission desk before admitting insured patients.
- Obtain all necessary insurance documents.
2. Pre-Authorization
- Prepare and submit pre-authorization requests.
- Coordinate with consultants for clinical documents.
- Follow up continuously until approval.
- Escalate delayed approvals.
- Maintain approval timelines.
3. Documentation
Collect and verify:
- Insurance card
- Identity proof
- Policy copy
- Claim forms
- KYC documents
- Consultant notes
- Investigation reports
- Consent forms
- OT notes
- Discharge summary
- Final bill
- Pharmacy records
- Implant stickers
- Investigation films/reports
Ensure zero documentation deficiencies.
4. Insurance Coordination
Coordinate with:
- TPAs
- Insurance Companies
- Corporate Insurance Panels
- Government Health Schemes
- Surveyors
- Medical Auditors
Maintain skilled communication throughout the patient journey.
5. Billing Coordination
Work closely with billing team to ensure:
- Accurate package billing
- Non-payable identification
- Excluded items explained to patient
- Timely bill updates
- Final bil