TPA Doctor

Paras Health Is hiring.

Job Description:

We are looking for a skilled and compassionate TPA Doctor to join our healthcare team. As a TPA Doctor, your primary responsibility will be to oversee the coordination between the hospital, patients, and insurance companies. You will be involved in assessing and processing medical claims, providing pre-authorization for treatments, and ensuring accurate documentation for insurance purposes.

Key Responsibilities:

• Clinical Support & Consultation: Provide medical expertise and consultations for pre-authorization and claims related to health insurance.
• Insurance Liaison: Act as the point of contact for TPAs and insurance companies, ensuring clear communication regarding patient claims and treatment approvals.
• Documentation & Reporting: Review medical records, prepare reports, and ensure accurate documentation for all TPA-related activities.
• Claims Verification: Verify medical claims submitted by patients or healthcare providers, ensuring accuracy and compliance with insurance policies.
• Pre-authorization Process: Review and authorize medical treatments, surgeries, diagnostics, and other procedures covered by health insurance.
• Dispute Resolution: Address any issues or discrepancies related to insurance claims and work towards their resolution in collaboration with the hospitals administrative team and the TPA.
• Patient Interaction: Communicate with patients regarding their insurance claims and treatment approvals, answering any questions they may have.
• Collaboration: Work closely with other healthcare providers and administrative staff to ensure smooth insurance claim processing.

Qualifications:

• Medical Degree: MBBS, MD, or equivalent medical degree from a recognized institution.
• Experience: Minimum 3 years of experience in a hospital or healthcare setting, preferably with experience in dealing with TPA/insurance-related functions.
• Knowledge of Insurance Policies: Familiarity with health insurance procedures, claims processing, and pre-authorization protocols.
• Communication Skills: Strong verbal and written communication skills to interact effectively with patients, medical staff, and insurance companies.
• Attention to Detail: Ability to review and process complex insurance claims accurately.
• Problem-Solving: Strong analytical and problem-solving skills, especially when dealing with insurance discrepancies or claim denials.

Preferred Skills:

• Knowledge of hospital management software and TPA systems.
• Experience with medical coding and billing.
• Certification in insurance management (if applicable).

Regards

Shobhit Nayal

9810802312