Need a TPA person for eye care hospital gurgaon sector 49

Contact Mr Nishant Chaudhary WhatsApp 91050 24073

Industry & Sector: Private healthcare — Ophthalmology / Eye Care hospital operating in Gurgaon (Sector 49). We provide clinical and surgical eye-care services, outpatient and inpatient workflows, and manage insured patient volumes through hospital-TPA partnerships.

Primary Job Title: TPA Coordinator (Medical Insurance & Cashless Claims)

Role & Responsibilities

• Manage end-to-end TPA interactions for insured patients: verify policy details, initiate pre-authorizations, and follow up for cashless approvals.
• Process IP and OP claims accurately: prepare and submit supporting documents, code procedures/diagnoses per hospital guidelines, and track claim lifecycle to resolution.
• Coordinate with clinical teams, billing, and OP/IP counters to ensure timely documentation and reduce claim rejections or delays.
• Resolve denials and escalations with TPAs: perform root-cause analysis, submit appeals or clarifications, and close pending claims within SLA.
• Maintain daily logs and dashboards for claims status, authorizations, reimbursements, and aging; escalate trends to department lead.
• Ensure compliance with insurer policies, hospital SOPs, and patient confidentiality requirements while supporting audit requests.
  
  

Skills & Qualifications

Must-Have

• Proven experience handling TPA processes and cashless authorizations in a hospital setting.
• Strong knowledge of medical insurance claim documentation and common rejection reasons.
• Hands-on experience with Hospital Information Systems (HIS) or EMR platforms for claims and billing.
• Advanced MS Excel skills for reconciliation, reporting, and claims tracking.
• Attention to detail, ability to manage multiple insurer portals, and follow insurer SLAs precisely.
• Fluent in English and Hindi; comfortable communicating with TPAs, patients, and clinical staff on-site.
  
  

Preferred

• Prior exposure to ophthalmology procedures, package pricing, and surgery authorization workflows.
• Experience with denial management and claim appeal preparation for large TPAs.
• Familiarity with local insurer networks and policy nuances for Gurgaon/Haryana region.
  
  

Benefits & Culture Highlights

• On-site role with direct patient interaction in a focused eye-care environment — strong opportunity to build domain expertise.
• Collaborative clinical and admin teams, with mentorship for process improvement and career progression.
• Competitive hospital-staff benefits and opportunities for training on HIS/claims tools.
  
  

Location: Gurgaon, Sector 49 — On-site role.

Employer: Medico Hub (Eye Care Hospital).

Skills: tpa,insurance,teams,appeals,documentation,his,skills,advanced,ophthalmology