TPA Manager
0 - 5 Years of Experience
Not disclosed 
Full TimeApollo Hospitals, Vijay Nagar, Indore
Indore, Madhya Pradesh, India
Posted on 28-03-2024
1 Vacancy
Description
- Supervise and mentor a team of TPA coordinators, claims processors, and administrative staff, providing guidance, training, and performance feedback to ensure efficient departmental operations.
- Oversee the processing and adjudication of health insurance claims submitted by patients, healthcare providers, and insurance companies, ensuring accuracy, completeness, and compliance with regulatory standards.
- Maintain relationships with insurance companies, TPAs, and managed care organizations (MCOs) to negotiate contracts, fee schedules, and reimbursement rates, ensuring favorable terms for the healthcare facility.
- Manage the authorization and pre-certification process for medical services, procedures, and hospital admissions, liaising with insurance companies and healthcare providers to obtain approval and ensure payment.
- Monitor billing processes, revenue cycle performance, and accounts receivable management to identify trends, address discrepancies, and maximize revenue generation from insurance reimbursements.
- Ensure compliance with regulatory requirements, contractual obligations, and industry standards governing health insurance claims processing, documentation, and confidentiality of patient information.
Category
Administration / Management
Key Skills
Team LeadershipClaims ManagementProvider Network ManagementBilling and Revenue CycleCompliance and Documentation
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