AM - IPD Billing & TPA (Deduction Recovery)

Job title

To Manage the TPA/Insurance Agreement and tariff updation and coordinate with TPA Insurance for payment follow up along with max internal team as well for day-to-day work.

Role & responsibilities

• To ensure customers TPA outstanding recovery within defined timelines.
• Achievement of assigned collection Targets.
• To maintain Insurance Tracker and updating of case status in E Prapti on weekly basis.
• Recovery of Top up deduction cases.
• TPA status of Outstanding cases prior to 30 days (Inclusive of Less than Rs. 10000).
• Bill docket receiving status prior to 30 days (Real time status basis on TPA records).
• Outstanding details to be shared with TPAs by 7th of every month.
• Relationship building with TPA key persons and arranging value added services across Pan max units.
• Working with TPAs networking/ Operation Managers to identify payout delay reasons and mitigate any issues being seen at TPA/MHC end.
• To provide NEFT dump to On Account team on fortnight/ Monthly basis.
• Resolution of On Account Team concerns/ requirements with in TAT of 72 hours.
• To capture correct status, TIN/CIN, Insurance Company name in Insurance Tracker.
• Post discharge Query resolution and updating in E Prapti.
• To identify reasons of wrong settlement cases and correction to be done with help of On-Account & Finance Team.
• Weekly report on action done against cheque Re Issue/paid by TPA but payout not received cases.
• Weekly TPA Visit Call Report. (Format already shared).
• On Account Settlement Prior to 90 days.

Cashless Troubleshooting

• Assisting unit Front office/ Billing teams on day-to-day issues faced during hospitalization of patient.
• Data/ records maintaining of support extending to unit TPA teams for cashless troubleshooting cases.
• Maintaining relationship & regular visits to Pan Max units.

Preferred candidate profile

Qualifications

Experience

Please share your CV

deen.dayal@maxhealthcare.com