As a Hospital TPA Coordinator, you will be responsible for managing the relationships and administrative processes related to third-party administrators, such as insurance companies and managed care organizations. Your role involves facilitating communication, ensuring timely processing of claims, and maintaining compliance with contractual agreements and regulatory requirements.

Responsibilities:

- Claims Processing:
- Receive, review, and process insurance claims submitted by patients or healthcare providers.
- Verify patient eligibility and coverage details with the TPA.
- Ensure claims are submitted accurately and promptly to maximize reimbursement.
- Communication and Coordination:
- Serve as the primary point of contact between the hospital and TPAs.
- Communicate effectively with TPAs to resolve claim issues, denials, and payment discrepancies.
- Collaborate with hospital billing and finance departments to streamline claim processing.
- Contract Management:
- Monitor and enforce contractual agreements with TPAs to ensure compliance.




- Negotiate rates and terms for services provided to insured patients.
- Update and maintain contract documentation and records.
- Documentation and Reporting:
- Maintain accurate records of TPA communications, claims status, and payments.
- Generate reports on claim processing metrics, reimbursement rates, and trends.
- Provide regular updates to hospital management on TPA performance and financial impact.
- Quality Assurance and Compliance:
- Ensure compliance with healthcare regulations and TPA requirements.
- Implement quality assurance measures to minimize claim errors and optimize reimbursement.
- Patient Advocacy:
- Assist patients with understanding their insurance coverage, advantages, and responsibilities.
- Advocate on behalf of patients to resolve insurance-related issues and ensure fair reimbursement.

Job Types: Full-time, Permanent

Pay: From ₹6,000.00 per month

Experience:

- total work: 1 year (Preferred)

Work Location: In person

📌 Office works (Katni)
🏢 Sparsh multispeciality hospital
📍 Katni