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Sterling Hospital - Head - TPA Insurance Operations

Sterling Hospital - Head - TPA Insurance Operations

Sterling HospitalsAhmedabad, India
30+ days ago
Job description

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 :

  • Lead 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.

    • Insurance Collection & Recoveries :

  • 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.

    • Revenue Cycle Management (Insurance Aspect) :

  • 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.

    • Qualifications & Experience :

  • 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.

    • ref : iimjobs.com)

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    Operation • Ahmedabad, India