Job Profile: TPA Coordinator Role

- Department: TPA / Insurance / Cashless Claims

- Reporting To: TPA Manager / Billing Head / Finance Manager

- Core Purpose: Manage cashless pre-authorizations, tracking, queries, discharges, and final claim settlements with TPAs and insurance/government panels. [1]

Key Responsibilities

- Pre-Authorization &
- Admission:

Verify patient insurance eligibility, policy caps, and ID cards upon admission; submit initial treatment estimates, clinical notes, and KYC documents to TPA portals. [1, 2]

- Enhancements &

- Approvals:

Track running bill limits, file enhancement requests mid-stay if estimates rise, and coordinate clinical updates with treating doctors. [1]

- Government Panels: Handle schemes like CGHS, ECHS, and Ayushman Bharat (PM-JAY) as per scheme guidelines. [1]

- Discharge Coordination: Obtain timely discharge approvals to prevent patient retention delays at billing counters. [1]

- Query &

- Deduction Management:

Address TPA queries,



respond to short-payments/deductions, and coordinate medical records justification. [1]

- MIS &

- Reporting:

Maintain daily/monthly tracking sheets for approved, pending, queried, rejected, and settled claims. [1]

Qualifications &

- Experience

- Education: Graduate in any discipline; Hospital Administration or Healthcare Management preferred.

- Experience: 2 to 5 years in hospital TPA desks, health insurance processing, or IPD billing. [1]

- Technical Skills: MS Office (MS Excel - VLOOKUP, pivot tables), hospital management/HIS software, and TPA online portals (Medi Assist, Vidal, MDIndia, etc.

- Soft Skills: Good verbal/written communication (English/Hindi), patience under pressure, and negotiation/follow-up discipline

Pay: ₹15,000.00 - ₹20,000.00 per month

Benefits

- Versatile schedule

Work Location: In person

📌 TPA Coordinator (Delhi)
🏢 Goyal hospital u0026 urology center
📍 Delhi