JOB DESCRIPTIONBilling & TPA Executive

Department: Billing / TPA
Designation: Billing & TPA Executive
Reporting To: Billing/Finance Manager or TPA Manager
Location: Hospital
Employment Type: Full-Time

1. Job Purpose

To manage hospital billing, insurance/TPA coordination, cashless and reimbursement claims, documentation, patient queries, and timely submission and settlement of insurance/TPA claims while ensuring accuracy, compliance, and excellent patient service.

2. Key ResponsibilitiesA. Patient Billing

- Prepare and process accurate inpatient and outpatient bills.
- Verify charges related to consultation, procedures, investigations, pharmacy, consumables, room rent, nursing, implants, and other hospital services.
- Ensure correct application of hospital tariffs, packages, discounts, and approvals.
- Coordinate with clinical and non-clinical departments for clarification of billing entries.
- Handle bill corrections, cancellations, refunds, and adjustments as per hospital policy.
- Ensure timely and accurate final billing at the time of patient discharge.

B. TPA & Insurance Coordination

- Coordinate with insurance companies, TPAs, patients, doctors, and hospital departments for cashless and reimbursement cases.
- Verify insurance/TPA eligibility, policy details, and required documents.
- Prepare and submit pre-authorisation requests with complete medical and financial information.
- Follow up for initial, interim, enhancement, and final approvals.
- Coordinate with the concerned departments for timely submission of required clinical documents.
- Ensure discharge approval and final authorisation are obtained before billing closure wherever applicable.
- Handle queries and clarification requests raised by TPAs/insurance companies.

C. Claims Processing

- Prepare and submit complete and accurate claims within defined timelines.
- Verify claim documents, including bills, discharge summaries, investigation reports, prescriptions, approvals, and other supporting documents.
- Track pending, approved, rejected,



and queried claims.
- Follow up regularly on outstanding claims and maintain proper records.
- Identify reasons for claim deductions/rejections and coordinate for correction or resubmission.

D. Patient & Attendant Coordination

- Explain billing and insurance/TPA procedures clearly to patients and attendants.
- Inform patients regarding approvals, non-payable items, deductions, deposits, and other financial requirements.
- Handle billing-related complaints and escalate unresolved issues appropriately.
- Maintain professional and empathetic communication with patients and relatives.

E. Documentation & MIS

- Maintain accurate records of all cashless and reimbursement cases.
- Maintain daily/monthly reports of admissions, discharges, approvals, claims submitted, outstanding claims, deductions, and settlements.
- Prepare TPA/insurance-related MIS reports as required by management.
- Ensure proper filing and confidentiality of patient and insurance documents.
- Support internal and external audits by providing required documentation.

3. Key Performance Indicators (KPIs)

- Billing accuracy and error rate.
- Timely completion of discharge billing.
- Pre-authorisation and enhancement turnaround time.
- Percentage of claims submitted within TPA/insurance timelines.
- Reduction in claim rejections and avoidable deductions.
- Timely follow-up and settlement of outstanding claims.
- Patient satisfaction regarding billing and insurance services.
- Accuracy and completeness of TPA MIS and documentation.

4. Qualifications

- Graduate in any discipline; preferably B.Com / BBA / Healthcare Management / Hospital Administration.




- Candidates with certification/coursework in medical billing, insurance, or hospital administration will be preferred.

5. Experience

- 1–3 years of experience in hospital billing, TPA desk, insurance coordination, or healthcare claims.
- Experience in a hospital/healthcare setting is preferred.
- Freshers with relevant qualifications and valuable communication skills may be considered for trainee positions.

6. Required Skills

- Good knowledge of hospital billing and insurance/TPA processes.
- Basic understanding of medical terminology and hospital services.
- Good communication and interpersonal skills.
- Strong documentation and follow-up skills.
- Good knowledge of MS Office/Excel and hospital information systems.
- Attention to detail and numerical accuracy.
- Ability to work under pressure and meet discharge/claim timelines.
- Ability to coordinate effectively with doctors, nurses, finance, patients, and insurance/TPA representatives.
- Good problem-solving and customer-service skills.

7. Behavioural Competencies

- Accountability and ownership.
- Professionalism and confidentiality.
- Patient-centric approach.
- Teamwork and coordination.
- Time management.
- Integrity and attention to detail.
- Ability to handle difficult situations calmly and professionally.

8. Working Conditions

- Willingness to work in rotational shifts, including weekends/holidays, as per hospital requirements.
- Ability to handle high patient volumes and time-sensitive discharge and insurance cases.

9. Authority & Escalation

The Executive shall resolve routine billing and TPA-related issues within the scope of hospital policies and escalate financial disputes, claim rejections, exceptional discounts, major deductions, and unresolved patient complaints to the concerned Manager/Department Head.

Pay: ₹15,000.00 - ₹18,000.00 per month

Benefits:

- Flexible schedule
- Paid sick time
- Provident Fund

Work Location: In person

📌 Billing and TPA Executive (Kolhapur)
🏢 Kolhapur Cancer Centre - Cancer Centers of America
📍 Kolhapur