Job Responsibilities of a TPA Coordinator (Hospital Billing Department)

1. Patient Admission & Pre-Authorization

- Verify patient insurance/TPA details at the time of admission.
- Collect required documents and submit cashless pre-authorization requests to the respective TPA.
- Communicate approvals, denials, or queries from TPA to patients and concerned departments.
- Ensure timely follow-up on pending pre-auth approvals.

2. Coordination With TPA / Insurance Companies

- Act as the primary point of contact between the hospital and TPAs/insurance companies.
- Respond promptly to TPA queries related to patient treatments, packages, line of treatment, etc.
- Maintain healthy working relationships with TPA representatives.

3. Billing & Documentation

- Ensure all medical records, treatment notes, investigation reports, and bills are accurate and complete.
- Prepare final bills for insured patients as per TPA tariff and agreements.
- Check admissibility of charges based on TPA policies and guidelines.

4. Cashless & Reimbursement Processing

- Process cashless discharge approvals by sending final bill and discharge summary to TPA.




- Assist patients in documentation for reimbursement claims.
- Ensure all claim forms are correctly filled, signed, and stamped.

5. Discharge Coordination

- Coordinate with doctors, nurses, and billing team to prepare discharge summary and documentation.
- Follow up with TPA for final authorization to avoid discharge delays.
- Communicate approved and non-approved items to patients clearly.

6. Claim Submission & Follow-Up

- Submit completed claims to TPA within timelines.
- Track and follow up on claim status to avoid rejections and delays.
- Re-submit additional documents or justifications requested by TPA.

7. Denial & Query Management

- Handle claim rejections, short-settlements, and TPA queries professionally.
- Coordinate with medical team to provide clarifications or additional documents.
- Maintain records of denials and initiate corrective actions.

Contact person : Human Resources

Contact Number : (phone hidden)

Email Address : [email protected]

📌 HEAD - TPA & Billing (Mumbai)
🏢 Criticare Asia Multispeciality Hospital
📍 Mumbai