Techno India Group
Website:
technoindiagroup.com
Job details:
FOR Nehru Memorial Techno Global Hospital, BARRACKPORE
A Hospital Third-Party Administrator (TPA) Executive or Coordinator acts as the vital link between patients, medical staff, and insurance companies to facilitate cashless treatments and claim settlements.
Core Responsibilities
- Pre-Authorization Management: Initiating and tracking pre-authorization requests for planned and emergency hospitalizations to ensure TPAs like Link-K Insurance TPA or Vidal Health approve coverage before or during treatment.
- Documentation & Verification: Collecting and verifying patient insurance cards, IDs, and policy documents at the admission desk.
- Billing Coordination: Collaborating with the hospital's billing department to ensure medical expenses align with insurance coverage and preparing accurate final bills for submission.
- Claim Processing: Submitting cashless and reimbursement claim documents to insurers through electronic portals and tracking their status.
- Patient Counselling: Guiding patients and families through the complexities of their insurance policies, coverage limits, and required documentation to reduce out-of-pocket stress.
- Scheme Management: Handling specific regional government schemes such as the Saswtya Sathi Scheme, West Bengal Health Scheme (WBHS) or Ayushman Bharat (PMJAY), ensuring compliance with state-specific guidelines.
- Dispute Resolution: Addressing claim rejections, short payments, or queries from TPAs by providing additional medical records or justifications from doctors.
Job Titles & Locations
- TPA Executive/Coordinator
- Location: Barrackpore, West Bengal
- Education: Usually a Graduate degree; Medical degrees (BAMS/BHMS/BDS) are preferred for senior processing roles.
- Skills: Proficiency in MS Excel, knowledge of IRDAI regulations, and familiarity with hospital management software
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