TPA Coordinator

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:

• Flexible schedule

Work Location: In person