Job Title: TPA Assistant

Department: Billing/Accounts Receivable

Reports to: Finance Manager

Job Summary: The TPA (Third Party Administrator) Coordinator is responsible for managing the relationship between the hospital and third-party insurance providers, ensuring accurate processing of claims and timely reimbursement. The coordinator will facilitate communication between patients, insurance companies, and medical staff to ensure a smooth billing process. This role includes verifying insurance coverage, processing claims, handling inquiries, and resolving issues related to insurance payments.

Key Responsibilities:

- Claims Management:
- Review and process insurance claims submitted to TPA providers.
- Ensure accuracy and completeness of all submitted claims.
- Monitor the status of claims and follow up as necessary to expedite reimbursement.
- Insurance Verification:
- Verify patient insurance coverage, benefits, and eligibility prior to services rendered.
- Communicate benefits and coverage limitations to patients and healthcare providers.
- Patient Communication:
- Serve as the point of contact for patients regarding third-party insurance inquiries.
- Provide clarification and explanation of insurance policies, coverage, and responsibilities.
- Dispute Resolution:
- Investigate and resolve issues related to denied or underpaid claims, including providing necessary documentation.
- Work collaboratively with insurance providers to appeal decisions when necessary.
- Data Management:
- Maintain accurate records of all communications, claims, and payments related to third-party insurance providers.
- Utilize billing software and databases effectively for tracking and reporting purposes.
- Collaboration and Coordination:




- Work closely with clinical staff, billing department, and insurance companies to ensure effective communication and resolution of issues.
- Collaborate with the finance team to prepare reports on claims, denials, and aging accounts.
- Compliance:
- Stay updated on changes in insurance policies, regulations, and healthcare laws that may affect billing and reimbursement.
- Ensure compliance with hospital policies and procedures regarding billing and insurance practices.
- Training and Support:
- Educate staff and patients on insurance processes and procedures.
- Train new employees on TPA processes and systems as needed.

Qualifications:

- Bachelor's degree in healthcare administration, business, or a related field preferred.
- Previous experience in healthcare billing, coding, or insurance verification preferred.
- Familiarity with medical terminology, billing codes, and insurance claim processes.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills to interact effectively with patients and insurance representatives.
- Proficiency in billing software and Microsoft Office Suite.

Work Environment:

- Primarily office-based, with potential for some work from home.
- May involve extended periods of sitting and typing.

Physical Requirements:

- Ability to communicate verbally and in writing.
- Comfortable using computers and other office equipment.

Join our dynamic team and contribute to the community [email protected] /[email protected]/[email protected] ·

Job Type: Full-time

Pay: ₹18,000.00 - ₹25,000.00 per month

Benefits

- Paid time off
- Provident Fund

Work Location: In person

📌 TPA Assistant (Mumbai)
🏢 Holy Family Hospital, Bandra
📍 Mumbai