K.J. Somaiya Hospital & Research Centre, a 550-bedded medical college and hospital in Sion, Mumbai, is hiring an Incharge – TPA to lead its TPA, MJPJAY and Corporate department.

Key Result Areas:

- Prepare and implement SOPs for smooth functioning of the TPA department
- Empanelment of TPAs and Corporates and renewal of MOUs within TAT
- Supervise accurate billing of TPA, MJPJAY and Corporate patients
- Ensure recovery of payments from TPAs and Corporates within TAT

- Work as CABG Coordinator

Key Responsibilities:

- Oversee daily admissions, discharges, TPA queries, claims, reimbursements and outstanding payments for TPA, MJPJAY and Corporate patients
- Implement corporate policy terms, conditions and protocols as per MOUs
- Ensure complete claim files are sent to TPA, MJPJAY and Corporates on time
- Verify pre-authorisation and final approval letters
- Cross-check final bills and discharge summaries before submission
- Liaise with TPA, MJPJAY and Corporates for empanelment, rates, discounts and MOU renewals
- Follow up on delayed or pending payments, including office visits when required
- Ensure payment settlements are updated in the system within TAT
- Coordinate with patients, consultants, TPAs and management for CABG package billing




- Guide patients and relatives on deductions and ensure settlement for cashless cases
- Resolve patient grievances and reimbursement claim queries
- Train departmental staff regularly and ensure patient satisfaction
- Prepare and submit monthly MIS reports to management
- Coordinate with other departments for smooth functioning
- Any other assignment given by management from time to time

Requirements: - Medical graduate (MBBS / BAMS / BHMS) is mandatory

- Strong knowledge of TPA, MJPJAY, corporate billing and cashless / reimbursement processes
- Understanding of medical terminology, hospital billing and MOU terms
- Negotiation, liaison and team leadership skills
- Good command of MS Excel and hospital software

Job Type: Full-time, Permanent Salary: As per qualification and hospital norms

Job Type: Full time

Benefits

- Health insurance

Application Question(s):
- Are you willing to work rotational shifts?
- How many years of hospital experience do you have?
- What is your current CTC per month?
- What is your expected CTC per month?

Education:
- Bachelor's (Required)

Work Location: In person

📌 Incharge – TPA (Sion)
🏢 K.J. Somaiya Hospital And Research Centre
📍 Sion