Position: TPA Coordinator Department: Insurance / TPA / Billing Department Reporting To: Hospital Administrator / Billing Manager / Finance Manager Location: Hospital Job PurposeThe TPA Coordinator is responsible for coordinating insurance and Third-Party Administrator (TPA) activities for patients, ensuring timely pre-authorisation, documentation, claim processing, discharge approvals, and settlement of insurance/TPA cases.

Key Responsibilities TPA &

- Insurance Coordination Coordinate with various TPAs, insurance companies, patients, doctors, billing and hospital departments. Handle cashless and reimbursement-related insurance cases. Verify patient insurance/TPA eligibility and policy details. Pre-Authorization Prepare and submit pre-authorisation requests to the concerned TPA/insurance company. Ensure all required medical documents, investigation reports, treatment details and estimates are submitted accurately. Follow up regularly for approval, query resolution and enhancement requests.

Patient

Admission &

- Documentation Assist patients and their attendants with insurance/TPA-related procedures. Collect and verify required documents such as insurance card, ID proof, policy details and other relevant records. Ensure proper documentation at the time of admission. Discharge &
- Final Approval Coordinate with the billing department and medical team for preparation of final bills and discharge summaries. Submit final bills and required documents to the TPA/insurance company for discharge approval. Follow up for final authorization and settlement.

Claim Processing

Prepare and submit complete claim documents within the prescribed timelines. Monitor pending, approved, rejected and query cases.



Coordinate with TPAs for clarification and resolution of claim queries. Coordination with Hospital Departments Coordinate with doctors, nursing staff, medical records, billing, pharmacy, diagnostic and other departments for required documents. Ensure timely availability of medical records and supporting documents. Follow-up &

- Record Maintenance Maintain proper records of all TPA/insurance cases. Track pre-authorisations, enhancements, discharge approvals, claim submissions, settlements and outstanding claims. Maintain daily/monthly reports of TPA cases and pending claims. Query &
- Rejection Management Identify reasons for claim queries, deductions or rejections. Coordinate with the concerned departments to provide appropriate clarification and supporting documents. Escalate unresolved issues to the reporting manager. Billing &
- Financial Coordination Coordinate with the billing/finance team regarding approved amounts, deductions, patient liability and outstanding payments. Check TPA/insurance settlements against submitted claims and approved amounts. Assist in reconciliation of TPA receivables. Compliance &
- Confidentiality Ensure compliance with hospital policies, insurance/TPA requirements and applicable procedures. Maintain confidentiality and security of patient and insurance-related information. Ensure accurate and timely documentation.

Required

QualificationsGraduate in any discipline; preferably BBA, B.Com, B.Sc., BAMS, Nursing, Healthcare Management or equivalent. Diploma/Certificate in Healthcare Management, Medical Billing, Insurance or TPA operations will be an advantage. ExperiencePreferably 1–3 years of experience in TPA/insurance coordination, hospital billing, cashless desk or healthcare administration.

📌 TPA Coordinator (Chandigarh)
🏢 SHRI DHANWANTRY AYURVEDIC COLLEGE AND HOSPITAL
📍 Chandigarh