- Manage end-to-end TPA and insurance desk operations for the hospital.
- Ensure timely processing of pre-authorizations, approvals, and discharge cases.
- Coordinate with TPAs, insurance companies, patients, doctors, and internal departments.
- Monitor claim submission, documentation, billing, and settlement processes.
- Ensure accurate and timely submission of insurance/TPA claims.
- Follow up on pending approvals, queries, deductions, and outstanding claims.
- Resolve claim-related discrepancies and coordinate for timely closure.
- Ensure compliance with TPA, insurance, hospital, and regulatory guidelines.
- Monitor claim rejection, denial, and deduction trends and take corrective action.
- Maintain accurate MIS and prepare regular reports on TPA performance and collections.
- Track outstanding amounts and coordinate with the billing/accounts team for recovery.
- Lead and guide the TPA desk team to achieve operational and financial targets.
- Ensure proper documentation and maintain records for audits and inspections.
- Develop solid working relationships with key TPA and insurance representatives.
- Drive process improvements to enhance patient experience, turnaround time, and revenue realization.