TPA / Cashless Executive-Raipur

JOB RESPONSIBILITY

1. Need to reach Hospital on Time and cross check the cleanliness of Cashless & TPA room, need to check proper working condition of internet, PC, Printers, Telephone Lines.

2. Should have an updated list of all TPA & Govt PSU on panel with updated MOU & Rate list as per agreed tariff, Email ID with Contact Number of costumer care and TPA Coordinator.

3. Should have proper knowledge of all the documents required for cashless approval, Preauthorization form, claim form and process like RSBY, BSBY, ECSH, CGHS.

4. Should handle entire billing part and documentation.

5. Should fill the accurate form , necessary document required and package opted & should send file to concerned TPA for approval , once the approval received should intimate reception staff to call and inform patient same and surgery appointment to be given accordingly.

6. Once the surgery is done should fill the claim form along with discharge summary & bill and should have scan copy of all & should courier the claim form after verification and should keep record of POD number.

7. Should maintain an excel tracker with all necessary detail and POD number & payment status against each case. Should know the payment cycle of each TPA, ECSH Govt PSU, RSBY , BSBY and take follow-up once the cycle date exceeds.

8. Will be responsible to avail approval within 24 hours of request and dispatch the claim file within 48 hours of billing , also if there is any query raised to be consulted to appropriate doctor and replied properly , all relevant query should be replied within 12 hours of query raised.

• 9. Monthly report should be made patient wise tracker with POD & Payment status & pending payment to be informed to central team.
• 10. All data should be scanned & saved soft copy & hard copy and should be provided when ever asked from central team.
• 11. Should report daily number of cashless surgery done at center on forum.
• 12. For any query should consult with IT, A/Cs & Cashless department in coordination with operations Manager.
• 13. Full responsibility from processing for approval till final payment received is liable on cashless department.
• 14. Weekly should check Govt website for any new or update on notification.
• 15. Need to cross verify all the bills and get it cross verified from the Operations Manager and get it signed before submission.
• 16. Before leaving from Hospital need to submit the day report and next day schedule to Operation Manager.

Desired Candidate Profile

• Good communication.
• Must have good command over MS Office.
• Candidate must have experienced in Third party/ Empanelment Corporate tie-ups.
• Must have experienced of Hospital.
• Must have Experienced TPA/Cashless/ECHS/CGHS processors.

Perks and Benefits

Performance based Incentives

Interested candidates may share their cv on WhatsApp 8875022129

Contact Person

Aarchi

HR Dept