A TPA (Third-Party Administrator) Billing Executive:
Pre-Authorization: Submit initial treatment estimates and clinical notes to insurance desks for cashless approvals.
IPD/OPD Billing: Generate accurate inpatient (IPD) and outpatient (OPD) final bills according to insurance rate caps.
Coordination: Liaise with TPA desk officers, insurance companies, and hospital departments for patient discharge clearances.
Deficiency Management: Resolve bill queries, deductions, or rejections raised by insurance adjusters.
A Government Panel Billing Executive (such as CGHS, DGEHS and other panels)
Scheme Registration: Verify patient eligibility, smart cards, and government referral letters at admission.
Compliant Billing: Prepare bills strictly aligned with government-approved package rates and standardized item codes.
Portal Submission: Upload physical and digital claim files onto specific government portals for processing.