Job Purpose The TPA Coordinator is responsible for coordinating cashless treatment, insurance and TPA-related activities for patients. The position involves coordination with patients, doctors, hospital departments, insurance companies and Third-Party Administrators (TPAs) to ensure timely pre-authorisation, claim processing, billing and discharge formalities.

1. Key Responsibilities

- Handle TPA/insurance desk operations and assist patients with insurance-related queries.
- Verify patient insurance/TPA details, policy validity and required documents at the time of admission.
- Coordinate with the concerned departments for cashless admission and treatment .
- Prepare and submit pre-authorisation requests to the concerned TPA/insurance company.
- Follow up regularly on pending pre-authorisation approvals and enhancements.
- Coordinate with doctors and clinical departments for medical information, treatment details and required reports.
- Ensure timely submission of medical records, investigation reports, prescriptions and other documents required by the TPA/insurance company.
- Coordinate with the billing department regarding estimated bills, final bills and patient payable amounts .
- Process and follow up on discharge approvals from TPAs/insurance companies.
- Coordinate with the medical records department for complete documentation before claim submission.
- Assist in preparation and submission of insurance/TPA claims within prescribed timelines.
- Track pending, approved, rejected and queried claims and maintain proper records.
- Respond to TPA queries and deficiencies and coordinate with concerned departments for timely resolution.
- Maintain a proper TPA-wise record of admissions, approvals, discharges and claims .
- Coordinate with insurance companies and TPAs regarding claim status,



deductions, rejections and settlements.
- Inform patients/attendants regarding insurance coverage, non-payable items, deductions and any amount payable by the patient, as per hospital policy and available approval.
- Ensure that all TPA/insurance documentation is complete, accurate and properly filed.
- Maintain confidentiality of patient, medical and insurance information .
- Coordinate with the accounts/billing department for reconciliation of TPA receivables.
- Follow up on outstanding TPA/insurance payments and provide necessary documentation whenever required.
- Maintain daily/monthly reports relating to TPA admissions, approvals, claims, rejections and outstanding amounts.
- Ensure compliance with hospital policies and applicable TPA/insurance procedures.
- Provide courteous and professional assistance to patients and their attendants throughout the insurance/cashless process.

1. Coordination Responsibilities

The TPA Coordinator shall regularly coordinate with:
- Patients and attendants
- Doctors/Consultants
- Nursing Department
- Emergency Department
- IPD/OPD Departments
- Billing & Accounts Department
- Medical Records Department
- Diagnostic/Laboratory Departments
- Pharmacy
- Insurance Companies
- Third-Party Administrators (TPAs)

1. Required Skills

- Good knowledge of hospital billing and TPA/insurance processes .
- Good communication and interpersonal skills.




- Ability to coordinate with multiple departments and external agencies.
- Good computer knowledge, including MS Office/Excel and hospital information systems (HIS/HMS) .
- Good documentation and record-maintenance skills.
- Ability to work under pressure and meet deadlines.
- Patient-friendly and service-oriented approach.
- Strong follow-up and problem-solving skills.
- Attention to detail and accuracy in documentation.

1. Educational Qualification

Minimum: Graduate in any discipline. Preferred: Graduate/Diploma in Hospital Administration, Healthcare Management, Medical/Insurance Claims, or a related field.

1. Experience

Preferably 1–3 years of experience in a hospital TPA/insurance desk, cashless department, hospital billing or insurance claims . Candidates with experience in handling major insurance companies/TPAs and cashless hospitalisation will be preferred.

1. Key Performance Indicators (KPIs)

- Timely submission and follow-up of pre-authorisation requests.
- Timely discharge approval and completion of cashless formalities.
- Accuracy and completeness of TPA documentation.
- Reduction in claim queries, rejections and documentation deficiencies.
- Timely submission of claims.
- Follow-up and reduction of outstanding TPA receivables.
- Patient satisfaction regarding TPA/insurance services.
- Proper maintenance of TPA records and reports.

1. General Duties

- Maintain professional conduct and confidentiality at all times.
- Follow hospital rules, policies and standard operating procedures.
- Perform any other TPA/insurance-related duties assigned by the Reporting Manager/Hospital Administration.
- Ensure smooth and effective functioning of the TPA/Insurance Desk.

📌 TPA CO-ORDINATOR (Chandigarh)
🏢 Shri Dhanwantry Education Society
📍 Chandigarh