TPA Executive With Counselling Experience

POSITION GUIDELINES

Document- / Responsibilities

DEPARTMENT : T.P.A.

POSITION : EXECUTIVE/ COORDINATOR

REPORTING TO : MANAGER

QUALIFICATION : GRADUATION / POST GRADUATION IN COMMERCE

EXPERIENCE : 1 - 5 YEARS

DRESS CODE : SPECIFIED DRESS CODE WITH I.D. CARD

DUTY HOURS : AS PER SCHEDULED REQUIREMENTS

Key areas of responsibility:

• Responsible for handling TPA Empanelment.
• Ensure that entire billing part and documentation part is as per requirement.
• TPA/Cashless /ECHS /CGHS /ESIC billing & documentation.
• Liaison with Govt. Health Departments.
• Liaison with Insurance Companies
• Tie ups with Corporate Houses.
• To timely solve the queries raised by the T.P.A.s in connection to the documents forwarded to them for seeking cashless transaction, in respect of the patient concerned under Medical Insurance Scheme.
• To give priority to emergency cases and to co-ordinate with the consultants / respective department for the same.
• To maintain appropriate departmental documentation.
• To treat all communication about patients, staff, and other organizational business confidentially.
• To be involved in quality Assurance / Quality control activities.
• To perform all the jobs as may be assigned due to exigencies of work.
• Participation in Continuous Quality Improvement.
• Ensure invoice is done without any delay.
• Also, need to ensure that the Invoice is submitted to the respective payers on time.
• Payment follow up religiously and ensure that the DSO is maintained as per the credit terms signed during empanelment