Associate - TPA & Corporate
- Manipal Hospitals
- 1 - 3 years
- Siliguri
- 8 months ago
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Job Description
- TPA Liaison:
- Serve as the primary point of contact between the hospital and TPAs, ensuring smooth claims processing and reimbursement.
- Collaborate with TPAs to verify patient eligibility, approve pre-authorizations, and facilitate smooth discharge procedures.
- Ensure timely submission of claims, follow up on outstanding claims, and resolve any discrepancies or issues related to TPA reimbursements.
- Corporate Client Coordination:
- Act as a liaison for corporate clients, addressing their queries and ensuring employees medical needs are met efficiently.
- Coordinate with corporate clients to manage employee health programs, including corporate insurance policies, wellness programs, and preventive health check-ups.
- Assist in the onboarding of corporate clients and ensure smooth setup for hospital services under corporate agreements.
- Claims Management:
- Monitor, track, and process claims submitted by patients under TPA and corporate agreements.
- Ensure all claims meet the required documentation and regulatory standards.
- Resolve claim issues and disputes in a timely manner, coordinating with both internal departments and external stakeholders.
- Documentation and Reporting:
- Maintain accurate records of all communications, claims, approvals, and payments from TPAs and corporate clients.
- Prepare regular reports on claims processing status, pending approvals, and financial reconciliations for internal and external stakeholders.
- Ensure all documentation is organized, up-to-date, and compliant with hospital policies and industry regulations.
- Customer Service:
- Provide exceptional customer service to patients, TPAs, and corporate clients by addressing inquiries and concerns promptly.
- Ensure patients and their families understand the process of claiming insurance and managing payments through TPAs or corporate policies.
- Cross-Functional Collaboration:
- Work closely with the billing, finance, and medical teams to ensure that patient care is seamless, and claims are processed efficiently.
- Collaborate with other hospital departments (admissions, discharge, accounts) to resolve any patient-related issues concerning TPA and corporate coverages.
- Compliance and Regulations:
- Stay updated with the latest regulations, policies, and procedures related to TPAs, corporate healthcare programs, and insurance claims.
- Ensure all processes align with the hospitals standards, legal requirements, and industry best practices.
Key Skills and Qualifications:
- Education: Bachelors degree in healthcare management, business administration, or related fields.
- Experience: 1-2 years of experience in TPA management, corporate healthcare coordination, or insurance claims processing is preferred.
- Skills:
- Strong communication and interpersonal skills to interact with TPAs, corporate clients, and internal teams.
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and hospital management systems.
- Ability to handle sensitive and confidential patient information.
- Attention to detail and strong organizational skills to manage multiple tasks simultaneously.
- Problem-solving skills to resolve claims and coordination issues.
Working Environment:
- The role typically operates in an office setting within the hospital or remotely, with periodic visits to patient care areas or meetings with external stakeholders.
- The job may involve working with insurance companies, corporate representatives, and patient families, requiring professional demeanor and strong customer service skills.
Job Classification
Industry: Medical Services / HospitalFunctional Area / Department: Customer Success, Service & OperationsRole Category: Customer Success, Service & Operations - OtherRole: Customer Success, Service & Operations - OtherEmployement Type: Full timeContact Details:
Company: Manipal HospitalsLocation(s): Siliguri+ View Contact
Keyskills: Mediclaim TPA Health Claims Insurance Claims Medical Insurance Claims Adjudication Health Insurance
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