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
Positive command of MS Excel and hospital software

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

Job Type: Full time

Perks
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