Tpa Executive

Role & responsibilities :

• Patient Support and Coordination:
• Assisting patients and their families with understanding insurance policies and procedures.
• Coordinating with patients, hospital staff, and insurance companies to ensure smooth and efficient treatment.
• Ensuring patients are eligible for cashless treatment.
• Providing updates on claim status to patients and their families.
• Claims Processing:
• Verifying patient eligibility and insurance coverage.
• Preparing and submitting claims to insurance companies.
• Tracking the status of claims and following up with insurance companies.
• Ensuring accurate and timely processing of claims.
• Pre-Authorization and Approvals:
• Obtaining pre-authorization for procedures and treatments.
• Ensuring all necessary documentation is submitted to insurance companies.
• Following up on approvals and denials.
• Compliance and Regulations:
• Ensuring compliance with relevant laws, regulations, and industry standards.
• Staying updated with changes in healthcare regulations and insurance policies.
• Maintaining accurate records and documentation.
• Other Responsibilities:
• Handling billing inquiries and resolving billing issues.
• Maintaining a positive and professional relationship with patients, staff, and insurance companies.
• May be involved in value-added services such as ambulance assistance and wellness programs.
• Qualifications and Skills:
• Strong understanding of insurance policies and procedures.
• Excellent communication, interpersonal, and customer service skills.
• Proficiency in using healthcare software systems and claims processing platforms.
• Ability to work independently and as part of a team.
• Attention to detail and ability to manage multiple tasks.
• Familiarity with medical terminology.