Application for the post of Hospital insurance and TPA Desk

Anand Eligar

Summary of Experience:

Working with Optimus Healthcare Solution an Hospital Insurance processing company as TPA executive and Coordinator .

Hospital Insurance cum TPA Executive from June 2018 to April 30th 2020 (1 year and 10 months) Vijayanagar Hospital, Bangalore.

January 15th 2014 to April 30th 2018(total 4 years and 3 months) as Hospital Insurance Coordinator/ TPA /Admin Coordinator in Garden City Hospital.

Worked with Manipal Omega Health management System in back end process for a medical billing US hospitals.

Area of Interest : Hospital TPA/Insurance Department /Health Insurance/Health Claims/ Cashless and Reimbursement claims

PROFESSIONAL EXPERIENCE

Optimus Healthcare Services Bangalore from June 2020 .

Processing of Hospital cashless claim for empaneled insurance and TPA.

Give accurate information about the documents required to prospective patients/admitted patients.

Getting all the forms filled by patients or attendants

Coordinating with Doctors, Wards for providing information in time.

Submitting papers to TPA in time and ensuring there is no slackness in such

Take the patient status for Cash or TPA from customer care dept.

Updating patients or attendants on their status from TPA

Helping customer on Reimbursement claims for insurance companies

Followup with the TPA and Insurer on the claim status.

Responding to the query for clinical and non clinical documents

Final Bill processing within correct maintained TAT

Sending documents to the insurance companies within the TAT and follow up with the insurer and TPA for payment status within the Stipulated time

Maintaining MIS reports and presenting to the management on the claim status

Attending weekly meetings as per the scheduled date and time.

Empaneling the hospital with the insurer for networking and Tie ups and work on the documents required.

Other duties assigned by the reporting manager.

Vijayanagar Hospital (Multispecialty Hospital with 71 bedded), Bangalore- June 2018 to April 30th 2020(1 year and 10 months)

Designation: Hospital Insurance cum TPA Executive/Cashless coordinator/Reimbursement claims

Counseling patient on Health Insurance/Claim

Coordinating with the insurance patient and collecting the documents for cashless claims.

Sending the preauth request to the insurance companies.

Doing the follow up for the initial approval with the companies via phone or through email.

Sending the final bill and discharge Summary to get the final approval for discharge patients

Check the patient Eligibility during planned and emergency admission.

Closing the IP credit Bills

Supporting with uploading documents on the platform

Directing patient and patient parties to the right place and right doctor.

Responding to the queries generated by the insurance/TPA, clinicial queries and non- clinical queries., Handling escalation calls/emails and resolving queries.

Collecting the copay amount from the credit patients.

Preparing monthly statistics or excel sheet of credit patient.

Preparation of document sets to TPA/Insurance companies and sending the same as per the agreed TAT.

Payments follow ups with the TPA’s and Insurance companies, handling payment related issue with Insurance.

Verification of all Insurance/ TPA and corporate bills for documentation

Coordinating with the billing team for final bill and copay receipts.

Resolve all queries from Insurance/ TPA and corporate with the help of respective departments.

Provide different additional queries regarding the health status and treatment procedure of the patients to concerned TPA.

Counseling patient on Reimbursement Health Claim

Responsible for short payment deductions happed during settlement of claims

Preparing MIS report on regular bases for IP cases and payment settled. Garden City Hospital, Jayanagar Bangalore – January 2014 to April 2018(4 Years 3 month) Designation: IP Billing and Insurance Executive

Provide safe & secure environment in the hospital for patients, visitors & staff

Co-ordination between employees and management

Liaison with Govt. Health Departments.

Counseling patient on Health Insurance/Claim

Help patient with pre-authorization.

Supporting with uploading documents on the platform.

Update patients and doctors about status of authorization, once the payment released reimbursing the same to the concerned doctors.

Reviewing and appealing unpaid and denied claims.

Maintaining accurate billing records of the patient and submit it whenever necessary.

Resolves billing issues by discussing contract with third-party payer; explaining insurance contract with patient; negotiating settlement

Identifies responsible party by examining patient record.

Directing patient and patient parties to the right place and right doctor.

Liaison with Insurance Companies.

TPA Empanelment with private and public sector insurance.

Tie ups with Corporate clients on Diagnostic services.

Signing up with new TPAs, Corporates & PSUs.

Check Eligibility during admission and discharge

Process the bills for clearance.

Payment follow up.

Responsible to handle reports & documentation

Responsible for daily Hospital Operations.

Coordinating with Clinical and Non clinical Staff

Identifies and resolves patient IP and OP billing complaints.

Prepares, reviews and sends patient statements

Performs daily backups on office computer system

Looking After In patient Billing and Out patient Billing.

Solving Patients day to day problems and Queries by co-ordinating with concern depts and giving them Proper Feedback and Solutions.

Networking with Corporate companies &creating partnerships with them.

Follow up of claim Insurance Billing.

Co-ordination between employees and management.

Provide different additional queries regarding the health status, treatment procedure of the patients.

Responsible for housekeeping, Hospital support staff, patient services.

Coordination with Billing and other Depts. for collection of paper documentation

Prepare daily report of the hospital and communicating the same to the MD.

Provide safe & secure environment in the hospital for patients, visitors & staff Manipal Omega Health Systems, Bangalore – May 2004 to Apr 2013 Last Designation: Hospital Billing process for a RCM client Key Accountabilities:

Led and successfully managed a team size of 25+ for an US based client in hospital industry

Guide the team on client led operations, managing team activities and training the subordinates

Periodic team meetings and represent the team in conference calls with clusters

Account management, determining game plan.

Conducting internal audits and identification of process issues.

Escalation of problems to Service Delivery Manager/Senior Manager

Working on scheduled activities

Client Coordination.

Transition of projects

Clear understanding of Client Requirements

Meeting SLAs Commitments

EDUCATIONAL QUALIFICATIONS

Post Graduate Diploma in Hospital Administration (PGDHA) from Apollo Hospital’s Medvarsity Hyderabad (affiliated to Martin Lurther Christian University, Meghalaya), 2013 to 2014.

Bachelor of Science (Chemistry) from University of Pune, 1998.

Diploma in eCommerce Technology (SEED), Pune, 2000 ADDITIONAL CREDENTIALS

Two weeks Internship on Hospital Administration in Apollo Hospital, Bengaluru.

Attended Two days’ workshop on Hospital Administration conducted by Association of Hospital Administration Bangalore chapter SASH 2014 with recent updates in Hospital Administration.

Successfully completed Project with Grade A on Effective Utilization of Bed in Hospital in NABH accredited NU hospital, Bangalore January 2014.

Won Golden Brick Award in Year 2012 for successful completion of 7 years.

Won the best team award and best team leader award in 2011

1st tier evaluation of updates/documents.

Certified Internal Counsellor Programme on NABH Standards conducted by QCI. STRENGTHS

Ability to work independently and with teams.

Strong attention to details and eye for details.

Proficient in MS Word, Excel, Outlook, PowerPoint and Internet.

Ability to perform tasks as per the policies and procedures of the organization.

Possess excellent communication skills.

Ability to develop and maintain good relationship with staff, patient and doctors

Excellent written and verbal communication skills. PERSONAL PROFILE

Nationality : Indian

Sex : Male

Marital Status : Married

Languages Known : English, Kannada, Hindi and Marathi Hobbies/Interests : Cricket, listening to music and cooking Address for communication : 18/6/1, 7TH MAIN 6TH CROSS, BALAJI LAYOUT PADMANABH NAGAR, BANGALORE 560 070

Mobile: 944-***-****

E-mail: ad6t0b@r.postjobfree.com

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