KEY SKILLS: Experience in healthcare industry especially hospital industry
YRS OF EXP: 4 to 6 Yrs
SALARY: As per Industry Standards
JOB DESCRIPTION:
- Oversee all TPA and health insurance company relationships.
- Ensure timely registration, empanelment, and renewal with various TPAs and insurers.
- Negotiate service agreements and tariff rates with insurance providers and TPAs.
- Supervise pre-authorization, billing, and claims submission processes.
- Ensure timely and accurate documentation for claims approval.
- Monitor and reduce claim rejections, denials, and delays.
- Coordinate with billing and finance teams to ensure prompt payment realization.
- Manage the insurance desk and ensure efficient patient interaction during admission, discharge, and claim settlement.
- Educate patients and families on insurance processes, eligibility, and documentation requirements.
- Ensure adherence to IRDAI and regulatory requirements.
- Maintain complete and accurate documentation for audits.
- Prepare MIS reports related to TPA activities, claim status, and financial recovery.
- Act as a liaison between hospital departments, TPAs, and insurers.
- Resolve disputes or issues arising from delayed payments, claim rejections, or miscommunication.
- Lead and manage the TPA/Insurance team.
- Train staff on claim handling, software systems, documentation protocols, and customer service.
- Analyze trends in claim rejection and implement corrective measures.
- Suggest improvements in systems or processes to enhance claim turnaround time and revenue.