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Sterling Hospital - Head - TPA Insurance Operations
Sterling HospitalsAhmedabad, India30+ days ago
Job descriptionLead negotiations with insurance companies and TPAs to secure favorable pricing agreements for hospital services. Conduct thorough analysis of costing and market rates to support negotiation strategies. Ensure that negotiated rates are accurately implemented in the hospital's billing system. Regularly review and renegotiate contracts to optimize revenue. Oversee the insurance billing and collection process to ensure timely submission of claims. Implement strategies to minimize claim rejections and maximize recovery rates. Monitor outstanding insurance receivables and proactively follow up for timely payments. Analyze rejection trends and implement corrective actions to improve claim accuracy. Ensure adherence to all relevant insurance regulations and guidelines. Collaborate with other departments (e.g., billing, finance, medical records) to optimize the end-to-end revenue cycle related to insurance payers. Identify and implement process improvements to enhance efficiency and reduce revenue leakage. Stay updated on changes in insurance policies, regulations, and industry best practices. Provide regular reports on insurance empanelment status, collection performance, and key performance indicators. Educational qualifications, e.g., bachelor's degree in business administration, Healthcare Management, or a related field. 10+ Years of expertise, preferably in a hospital setting managing TPA and insurance relations. Strong leadership ability of the relationship building Business Acumen Negotiation Skills Proven track record of successful insurance empanelment, price negotiation, and collection recovery. Strong understanding of healthcare insurance processes, regulations, and billing practices. Excellent negotiation, communication, and interpersonal skills. Strong analytical and problem-solving abilities. Proficiency in relevant software and MS Office Suite.
Head TPA Responsibility :
Insurance Empanelment & Relationship Building :
- Identify and target key insurance providers for empanelment to expand the hospital's network.
- Lead the process of empanelment, including application, documentation, and site visits.
- Develop and maintain strong, collaborative relationships with key personnel at TPA and insurance companies.
- Act as the primary point of contact for all insurance-related matters.
- Proactively address any issues or concerns raised by TPAs or insurance providers.
Price Negotiation with Insurance Companies :
Insurance Collection & Recoveries :
Revenue Cycle Management (Insurance Aspect) :
Qualifications & Experience :
ref : iimjobs.com)
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Operation • Ahmedabad, India
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