Incharge - TPA (Doctor)

K.J. Somaiya Hospital & Research Centre, a 550-bedded medical college and hospital in Sion, Mumbai, is hiring an Incharge - TPA to lead its TPA, MJPJAY and Corporate department.

Roles and Responsibilities

• Prepare and implement SOPs for smooth functioning of the TPA department
• Handle empanelment of TPAs, MJPJAY and Corporates and ensure renewal of MOUs within TAT
• Negotiate best rates and discounts with TPAs, MJPJAY and Corporates
• Oversee daily admissions, discharges, TPA queries, claims, reimbursements and outstanding payments
• Supervise accurate billing of TPA, MJPJAY and Corporate patients as per MOU terms
• Verify pre-authorisation and final approval letters
• Cross-check final bills and discharge summaries before submission to TPAs
• Ensure complete claim files are sent to TPA, MJPJAY and Corporates within timelines
• Ensure recovery of payments within TAT and follow up on delayed or pending payments, including visits to TPA offices when required
• Ensure payment settlements are updated in the system within TAT
• Coordinate with patients, consultants and management for CABG package billing
• Guide patients and relatives on deductions and ensure settlement for cashless cases
• Resolve patient grievances and reimbursement claim queries
• Conduct regular training for departmental staff
• Prepare and submit monthly MIS reports to management
• Coordinate with other departments for smooth functioning

Desired Candidate Profile

• Medical graduate (MBBS / BAMS / BHMS) is mandatory
• Valid registration with the respective Maharashtra council
• Experience in handling TPA, MJPJAY and corporate billing in a hospital setup
• Strong knowledge of cashless and reimbursement processes and TPA portals
• Good understanding of medical terminology, hospital billing and MOU terms
• Negotiation, liaison and team leadership skills
• Good command of MS Excel and hospital software

Perks and Benefits

• Opportunity to lead the TPA department of a 550-bedded medical college and hospital
• Structured working environment with exposure to TPA, MJPJAY and corporate accounts
• Salary as per qualification and hospital norms

The roles and responsibilities mentioned above are indicative and may be modified from time to time as per organisational requirements.

* Immediate joiners or candidates with a short notice period will be preferred