TPA/ Billing Executive

Job Description TPA / Billing Executive

Company: Nexus Pain Management
Department: Accounts / Operations
Position: TPA / Billing Executive
Reports To: Center Manager / Operations Manager

Job Summary

Nexus Pain Management is looking for a detail-oriented and experienced TPA / Billing Executive to manage patient billing, insurance/TPA coordination, pre-authorizations, claims, and payment follow-ups. The candidate will ensure accurate billing and smooth coordination between patients, doctors, insurance companies, and internal departments.

Key Roles & Responsibilities

• Handle patient billing and ensure accurate preparation of bills and invoices.
• Coordinate with TPA and insurance companies for cashless approvals and claim processing.
• Prepare and submit documents for pre-authorization, enhancements, and final approvals.
• Follow up with insurance companies and TPAs for pending approvals and claims.
• Verify patient insurance eligibility, policy coverage, and required documentation.
• Coordinate with patients regarding insurance documents, co-payments, deductions, and non-covered expenses.
• Maintain proper records of approved, pending, rejected, and settled insurance claims.
• Handle billing corrections, cancellations, refunds, and payment reconciliation as per company policy.
• Coordinate with the Front Office, Doctors, Finance, and Operations teams for smooth patient discharge and billing.
• Ensure all billing and TPA documentation is completed accurately and within the required TAT.
• Prepare daily/monthly reports related to billing, collections, pending claims, and insurance settlements.
• Maintain confidentiality of patient and financial information.
• Resolve patient queries related to bills, insurance approvals, and payments professionally.

Candidate Requirements

• Any Graduate or relevant qualification in Healthcare/Hospital Administration, Finance, or Accounts.
• Experience in Hospital Billing, TPA, Insurance, or Cashless Claims is preferred.
• Knowledge of insurance and TPA processes, pre-authorizations, and claim documentation.
• Good communication and coordination skills.
• Basic knowledge of MS Excel and billing systems/software.
• Ability to work under pressure and handle multiple patient cases simultaneously.
• Attention to detail and strong follow-up skills.

Preferred Experience

1–3 years of experience in Hospital Billing / TPA / Insurance Claims.

Join Nexus Pain Management and be part of a growing healthcare organization focused on delivering quality patient care.