Billing & TPA Executive (1 week Night shift/month)

Job Title: Patient Experience Executive Billing, TPA & Estimate

Department: Patient Services / Front Office / Billing

Reports To: Patient Services Manager / Hospital Administrator

Location: Mumbai, Charni Road

Employment Type: Full-Time

Time: One week in a month, night shift

Job Summary:

The Patient Experience Executive Billing, TPA & Estimate is responsible for ensuring a seamless, transparent, and empathetic experience for patients related to financial services. This includes preparing cost estimates, coordinating with Third Party Administrators (TPA), processing billing activities, and resolving patient queries regarding payments, insurance, and pre-authorizations.

Key Responsibilities:

1. Billing and Estimation:

• Prepare accurate cost estimates for outpatient, inpatient, surgeries, and procedures.
• Ensure estimates include room charges, doctor fees, OT charges, consumables, and medications.
• Update billing records in the hospital management system (HIS).
• Handle provisional and final billing processes.
• Coordinate with the finance team to explain patient dues, deposits, and refunds.

2. TPA / Insurance Coordination:

• Liaise with insurance/TPA providers for pre-authorizations, approvals, and claims processing.
• Submit required documents and follow up on authorization status.
• Track and document communication with TPA partners.
• Educate patients on their insurance coverage, eligibility, and exclusions.
• Ensure timely submission of discharge summaries and final bills to TPA.

3. Patient Experience:

• Provide empathetic and clear communication to patients and families regarding billing and insurance.
• Handle patient concerns and escalate complex queries to the appropriate department.
• Guide patients through the admission and discharge financial processes.
• Ensure patient satisfaction through transparency and responsive service.

Qualifications:

• Bachelors degree in Healthcare Administration, Commerce, or related field
• Minimum 16 years of experience in hospital billing, TPA coordination, or patient services
• Knowledge of insurance procedures and healthcare billing systems
• Proficient in MS Office and hospital information systems (HIS)
• Strong communication and interpersonal skills
• Fluency in English and local language

Key Skills:

• Medical billing and coding knowledge
• TPA and insurance coordination
• Estimation and costing in healthcare
• Patient communication and conflict resolution
• Attention to detail and documentation
• Familiarity with NABH/JCI guidelines (preferred)