Insurance Coordinator

Job description:Job SummaryAs ANC currently operates without direct insurance tie-ups, this role is twofold:- Network Growth: You will actively visit and negotiate with TPA and Insurance companies to secure official empanelment (cashless tie-ups). - Patient Support: You will manage the entire reimbursement documentation process for patients, ensuring they have everything required to successfully claim their medical expenses from their respective insurers post-discharge. If required applying for reimbursement on behalf of the patientsKey Responsibilities:1. Empanelment & Networking (Primary Objective):- Business Development: Actively visit TPA offices (e.g., Medi Assist, Heritage, Raksha) and Insurance companies to initiate the empanelment process. - Documentation for Tie-ups: Prepare and submit the "Hospital Empanelment Form" along with required licenses - Negotiation: Negotiate tariff rates and Service Level Agreements (SLAs) that are favorable to the hospital’s revenue goals.2. Reimbursement Management (Patient Support):- Proactive Documentation: Since we are "Non-Cashless," you will take full ownership of the patient’s reimbursement file. This includes: - Ensuring the Discharge Summary is clinically detailed to prevent insurer queries. - Compiling all original reports - Correctly filling out Part-A and Part-B of the insurance claim forms on behalf of the patient. - Claim Counseling: Explain to patients exactly how the reimbursement process works, the expected timelines, and what "non-medical" expenses they should be aware of.3. Knowledge & Compliance:- Market Intelligence: Maintain an updated database of the reimbursement requirements for all major insurers (Star Health, Niva Bupa, HDFC Ergo, etc.) as processes vary between companies. - Query Resolution: If a patient’s claim is contested, you will act as the hospital's representative to provide the necessary medical justifications to the insurance company.Required Skills & Qualifications:- Experience: 3–5 years specifically in TPA Empanelment and Insurance Sales/Operations within the Hyderabad healthcare market. - Connections: Existing relationships with TPA network managers in Hyderabad is a significant advantage. - Communication: Exceptional persuasion skills. Must be fluent in Telugu and English to navigate both local patient needs and corporate insurance meetings. - Technical Knowledge: Deep understanding of why claims get rejected and how to "bulletproof" a reimbursement file.Performance Metrics (KPIs):- Number of new TPA/Insurance tie-ups secured per quarter. - Percentage of patient claims successfully settled (Reimbursement success rate). - Reduction in patient grievances regarding insurance documentation.Hope you have read the complete job description: If you have experience with processing Health Insurance reimbursements, Claims and Executing Agreements with TPA's and Insrances, whatsapp resume on 9030003460

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