TPA Coordinator - DR. OM PARKASH EYE INSTITUE - Amritsar, Punjab
(2025-08)
- Claims Management: Handle the accurate submission and tracking of both cashless and reimbursement medical claims to various TPAs and insurance providers.
- Pre-Authorization: Facilitate the approval process for medical procedures by coordinating with doctors to obtain necessary medical records and submitting pre-auth requests within strict deadlines (often within 24 hours of admission).
- Eligibility Verification: Review and verify patient insurance policies, photo IDs, and coverage limits at the time of admission to determine benefit eligibility.
- Discrepancy Resolution: Actively follow up on pending claims, resolve queries or rejections, and handle the resubmission of corrected documentation.
- Patient Counseling: Provide guidance to patients and their families regarding insurance terms, approval status, and claim procedures to ensure a smooth discharge process.
- Reporting & MIS: Maintain daily MIS (Management Information System) reports on claim statuses, Turnaround Time (TAT), and overall TPA performance for management review.
- Compliance: Ensure all documentation adheres to IRDAI (Insurance Regulatory and Development Authority of India) norms and internal hospital billing protocols.
- Inter-departmental Coordination: Work closely with the billing, finance, and nursing departments to align medical documents with billing requirements
TPA handler - Care and Cure medicity Hospital - Amritsar, Punjab
(2024-10 - 2025-07)
- Responsible for initiating and managing insurance case intimations for both cashless and reimbursement claims.
- Coordinated with insurance companies and TPAs to ensure timely approval and processing of patient claims.
- Verified policy details, pre-authorization documents, and patient records to support accurate claim submission.
- Maintained clear communication with patients, billing departments, and insurers for seamless claim handling.
- Ensured compliance with hospital policies and insurance guidelines to minimize claim rejections or delays.
- Assisted in preparing daily reports and maintained accurate records for audit and follow-up.
IELTS trainer - CM Study solutions - Amritsar, Punjab
(2023-11 - 2024-07)
