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
