Key Responsibility Areas (KRAs) TPA Coordinator (ESIC Billing & Related Work)ESIC Billing & Claims Processing:Manage end-to-end processing of ESIC patient admissions, treatment approvals, and claim submissions.Ensure accurate and timely submission of bills to ESIC authorities.Maintain updated knowledge of ESIC policies, tariffs, and documentation requirements.Coordination with TPA & Insurance Authorities:Act as a liaison between the hospital, ESIC, and third-party administrators (TPAs).Follow up on pending claims and resolve discrepancies to ensure timely reimbursements.Handle pre-authorization requests, approvals, and claim adjudication queries efficiently.Compliance & Documentation:Ensure all ESIC and TPA-related documentation is complete and accurate.Adhere to regulatory requirements and hospital policies concerning ESIC claim management.Maintain meticulous records of claims submitted, processed, and pending.Patient Assistance & Grievance Handling:Guide patients and their families on ESIC benefits, eligibility, and claim procedures.Address and resolve patient grievances related to ESIC billing and insurance claims.Provide assistance in case of claim denials or delays.Billing & Revenue Cycle Management:Collaborate with the finance and billing departments to ensure accurate billing and reconciliation.Monitor claim rejection trends and work towards process improvements to minimize revenue loss.Prepare and present periodic reports on ESIC claim status and financial recoveries.Stakeholder Coordination & Process Improvement:Work closely with hospital administration, finance, and medical teams to streamline the ESIC billing process.Suggest improvements in TPA and ESIC claim workflows to enhance efficiency and reduce turnaround time.Conduct periodic training for hospital staff on ESIC claim handling and documentation requirements.MIS & Reporting:Prepare and submit reports on ESIC billing, pending claims, and revenue generation.Maintain dashboards for tracking claims and ensuring timely follow-ups.Provide management with insights on key billing metrics and bottlenecks.Performance Metrics:Turnaround time for ESIC claims submission and processing.Percentage of claims approved without queries or rejections.Amount of revenue recovered from ESIC claims.Patient satisfaction levels concerning ESIC claim handling.Compliance with ESIC documentation and regulatory requirements.Preferred candidate profile:Qualifications: Master's in Hospital Administration( MHA) , MBA (Hospital Management)Experience: 3 - 7 years of Experience as TPA Manager in healthcare industry