TPA Billing Executive

The TPA Billing Executive will handle all activities related to insurance billing, cashless approvals, claim documentation, and coordination with Third Party Administrators (TPAs) and insurance companies. This requires strong knowledge of healthcare billing processes, insurance policies, and documentation standards. The candidate must ensure accuracy, transparency, and timely claim processing while maintaining high levels of patient satisfaction and compliance.

Roles and Responsibilities:

• Process TPA and insurance billing for IPD and OPD patients accurately.
• Coordinate with insurance companies and TPAs for pre-authorization and cashless approvals.
• Verify patient insurance eligibility, policy coverage, and documentation requirements.
• Prepare and submit complete claim documents to TPAs and insurance providers.
• Ensure timely follow-up on pending approvals, claims, and settlements.
• Coordinate with doctors, nursing staff, and billing departments for required medical records and documents.
• Review and verify patient bills, treatment details, and supporting documents before claim submission.
• Resolve claim discrepancies, rejections, and queries from TPAs and insurers.
• Maintain accurate records of claims, approvals, denials, and settlements.
• Ensure compliance with insurance guidelines, hospital policies, and regulatory requirements.
• Handle patient and attendant queries related to insurance and billing processes.
• Coordinate discharge clearance for insured patients to minimize delays.
• Maintain proper documentation and filing of insurance and TPA records.
• Generate daily, weekly, and monthly MIS reports related to TPA billing and claims.
• Follow up on outstanding payments and pending claims for timely recovery.
• Ensure transparency while communicating financial information to patients and insurers.
• Coordinate with accounts department for reconciliation and payment tracking.
• Assist in audits and ensure billing records are audit-ready.
• Maintain confidentiality of patient and financial information.
• Ensure proper usage of HIS/ERP systems for billing and claim processing.
• Stay updated with insurance policies, TPA guidelines, and healthcare billing practices.
• Support process improvement initiatives to reduce claim rejection rates.
• Maintain professionalism, communication standards, and customer service excellence.
• Handle multiple claims and billing activities efficiently under deadlines.
• Ensure compliance with NABH standards and documentation protocols.
• Participate in training and skill enhancement programs.
• Coordinate with corporate and marketing teams for empanelment activities when required.
• Maintain discipline, punctuality, and accountability.
• Contribute to improving revenue cycle efficiency and patient satisfaction.