Tpa Manager

Key Responsibilities:

• Supervision and Administration:

  Overseeing the overall administration of the PM-JAY scheme at the district level, including compliance with guidelines.

• Beneficiary Management:

  Ensuring accurate identification of eligible beneficiaries and facilitating their access to healthcare services.

• Service Utilization:

  Monitoring the utilization of services under the scheme, including pre-authorizations and claims processing.

• Awareness and Expansion:

  Generating awareness about the scheme among the public and expanding the network of participating hospitals.

• Monitoring and Auditing:

  Conducting regular monitoring and random audits of pre-authorizations and claims to ensure quality and timeliness of data.

• Data Management:

  Maintaining and reporting program data, ensuring its accuracy and completeness for report generation.

• Coordination and Communication:

  Working with various stakeholders, including the state health authority, hospitals, and other relevant parties, to ensure smooth operations.

• Quality Assurance:

  Conducting routine and surveillance visits to ensure all processes are running according to defined standards.

• Training and Capacity Building:

  Organizing training programs for healthcare providers and other stakeholders to enhance their understanding and implementation of the scheme.

Qualifications and Experience:

• Essential:

  A bachelor's degree in medicine (MBBS), MBA in healthcare, Master of Health/Hospital Administration, or Master of Public Health.

• Essential:

  At least 2 years of experience in implementing a government health insurance program, the insurance industry, or with a TPA.

In essence, a TPA in Ayushman Bharat plays a crucial role in the effective implementation and management of the scheme at the district level, ensuring that beneficiaries have access to quality healthcare services and that the program operates efficiently and transparently.