Insurance Executive

About Andhra Prime Hospitals

Andhra Prime Hospitals, located in Guntur, is a rapidly expanding healthcare institution accredited by NABH. The hospital is dedicated to offering superior patient care and maintaining efficient operational workflows, emphasizing clinical excellence, patient contentment, and ethical healthcare standards.

Role Overview

The Hospital Insurance Executive will oversee and manage third-party administrator (TPA) and insurance functions within the hospital. Key duties include managing cashless hospitalization requests, pre-authorization and enhancement submissions, reimbursement claims, maintaining documentation, and facilitating claim settlements. The role demands collaboration with multiple stakeholders such as patients, medical staff, billing, medical records, TPAs, and insurance providers to ensure swift processing and resolution of insurance-related processes.

Primary Responsibilities

• Manage approvals for cashless hospitalizations from TPAs and insurance providers.
• Verify insurance eligibility, policy specifics, limitations, and associated documentation for patients.
• Compile and submit pre-authorization requests, monitoring progress diligently.
• Handle enhancement requests during patient hospitalization and ensure timely follow-up.
• Liaise with clinical, billing, and records departments to compile necessary documentation.
• Process documentation for both cashless and reimbursement claims.
• Assist patients and their guardians with procedures related to insurance and claims.
• Monitor pending approvals, resolve queries or claim denials, and ensure claim settlements are completed promptly.
• Coordinate with TPAs and insurance companies to address queries and expedite approvals.
• Follow up persistently on outstanding claims and insurance receivables.
• Facilitate claim settlements and ensure reconciliation with insurance providers.
• Maintain detailed and accurate records concerning insurance cases, claims, and approvals.
• Generate and maintain management information system (MIS) reports for TPA and insurance activities.
• Ensure adherence to NABH standards, internal hospital policies, and TPA and insurance guidelines.
• Maintain confidentiality and accuracy of patient-related medical and financial data.
• Promptly escalate any delays or discrepancies impacting patient discharge or claim processing.

Qualifications and Experience

• Possess a bachelor's degree in any field; additional qualifications in healthcare administration or hospital management are desirable.
• Prior experience in hospital insurance or TPA operations, healthcare claims processing, or hospital billing is preferred.
• Proficient in MS Office applications, especially Word and Excel.
• Experience working in NABH-accredited hospitals is an advantage.
• Familiarity with major TPAs and health insurance providers.
• Experience managing cashless hospitalization, pre-authorizations, billing coordination, and claim settlements.

Skills and Competencies

• Knowledge of health insurance and TPA operations.
• Expertise in handling cashless authorization and pre-authorization procedures.
• Strong skills in claims processing and insurance documentation management.
• Effective coordination with hospital billing and medical documentation teams.
• Excellent communication and collaborative abilities.
• Strong follow-up and issue resolution capabilities.
• Ability to prepare detailed MIS reports.
• High attention to detail and accuracy.
• Proficiency in Microsoft Office tools.

Compensation and Opportunities

The position offers a competitive salary commensurate with experience and qualifications, alongside career growth potential in hospital insurance operations, revenue cycle management, and healthcare administration within a NABH-accredited environment.

Additional Information

Job Type: Full-Time
Location: Andhra Prime Hospitals, Guntur, Andhra Pradesh, India