Sterling Hospital - Head - TPA Insurance Operations

Head TPA

Key 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.