Job Code : 2797

TPA Consultant

The ideal candidate should have minimum 10 years of experience in a TPA cell within a hospital setting and be well-versed in handling the complete cycle of patient approvals, claims processing, reconciliations, and recovery follow-ups.

The role also involves coordination with insurance companies, empanelment of new TPAs, and ensuring timely collections and documentation.

Responsibilities

• Oversee the end-to-end TPA process, including patient pre-authorization, final approval, and billing coordination.
• Liaise with various insurance companies and TPAs to ensure smooth communication and claim settlement.
• Handle reconciliations and timely follow-ups for outstanding payments and shortfalls.
• Monitor turnaround time for approvals, and ensure minimal delays in patient discharge processes.
• Maintain accurate and updated documentation for all TPA-related interactions and audits.
• Coordinate with clinical and non-clinical departments to ensure complete and compliant claim submissions.
• Prepare and share regular MIS reports and dashboards related to TPA collections, rejections, and receivables.
• Manage and on board new TPAs, corporates, and insurance panels for expanding the hospital’s network.
• Address queries from patients and insurers with professionalism and clarity.
• Revenue Optimization: Implement strategies to minimize claim denials, expedite payment collections, and ensure that the organization is reimbursed correctly according to payer contracts.

 Skills & Qualifications

• Graduate in Hospital Administration or Healthcare Management with MBA im Finance.
• Minimum 10 years of relevant experience in heading the TPA department of a hospital.
• Strong understanding of TPA protocols, insurance guidelines, and hospital billing systems.
• Excellent communication and negotiation skills to handle insurance partners and patients.
• Proficiency in MS Excel, hospital information systems (HIS), and TPA software.
• Ability to manage time-sensitive processes under pressure with high attention to detail.
• Knowledge of relevant statutory regulations, including IRDA guidelines.