Kamthe Piles Hospital

Kondhwa Budruk, Pune

As a TPA Executive, you will play a crucial role in facilitating the smooth and efficient management of insurance claims. You will work closely with clients, healthcare providers, and insurance companies to ensure that all transactions and communications are handled effectively.**Key Responsibilities:**- **Claim Processing:** Review and process claim documents, ensuring all necessary paperwork is complete and compliant with insurance protocols.- **Client Coordination:** Communicate with clients to gather required information and updates regarding their claims, addressing any questions or concerns they may have.- **Provider Liaison:** Work with healthcare providers to verify patient eligibility and benefits, ensuring that services rendered are aligned with the insurance coverage.- **Documentation Management:** Maintain detailed records of claims processed, communications, and resolutions to ensure transparency and compliance with company standards.- **Problem Resolution:** Address and resolve any issues or discrepancies that arise during the claims process, collaborating with relevant parties to achieve satisfactory outcomes.**Required Skills and Expectations:**Candidates should have at least 2 to 4 years of experience in a similar role, demonstrating a strong understanding of the insurance claims process. A minimum education level of 12th pass is required. Excellent communication skills are essential for effective interaction with clients and providers. Proficiency in Microsoft Office, particularly Excel, is expected for managing documentation and data. Candidates should be detail-oriented, capable of handling multiple tasks efficiently, and possess strong problem-solving abilities to navigate challenges in the claims process. A professional attitude and the ability to work in a team are also important for success in this role.

We are seeking a TPM Coordinator to join our team in Katraj Kondhwa Road. The ideal candidate will have 2 to 4 years of experience and a minimum education of 12th pass. This full-time role requires a proactive individual to coordinate and support various TPM activities effectively.**Key Responsibilities:**- **Coordinate TPM Activities:** Assist in the planning and execution of Total Productive Maintenance initiatives, ensuring all tasks are completed on schedule.- **Documentation Management:** Maintain accurate records of TPM activities and progress reports, facilitating easy access to information for the team.- **Training Support:** Help arrange and deliver training sessions for staff on TPM best practices, enhancing overall understanding and implementation.- **Performance Monitoring:** Track the performance metrics of TPM initiatives and prepare reports to provide insights into areas for improvement.- **Cross-Department Collaboration:** Work closely with different departments to promote TPM strategies and gather feedback for continual improvement.**Required Skills and Expectations:**- Strong organizational skills are essential to keep track of multiple TPM tasks and deadlines efficiently.- Good communication skills to clearly convey information and collaborate effectively within teams.- A proactive attitude toward learning new TPM concepts and improving existing processes.- Basic knowledge of maintenance practices and equipment is preferred to understand the TPM framework better.- A results-driven mindset to focus on achieving the set TPM goals and contributing to overall operational excellence.

HANDLE CASHLESS AND REIMBURSEMENT CLAIM PROCESSINGCOORDINATE WITH INSURANCE COMPANIES TPA FOR APPROVAL AND QUERRIESVERIFY PATIENTINSURANCE ELIGIBILITY AND DOCUMENTSSUBMIT AND TRACK PREAUTHORISATION REQUEST PREPARED DAILY MONTHLY REPORT OF CLAIM

Talking preauth Ipd billing Reiumbusment claim procedure Communication with claim company about queries

- Provide direct patient care: As a Staff Nurse GNM, you will be responsible for delivering high-quality nursing care to patients under the supervision of senior healthcare professionals.- Monitor patient vital signs: You will regularly assess and record patients' vital signs, including blood pressure, heart rate, and temperature, to ensure their health and well-being.- Administer medications: It will be your duty to accurately administer medications to patients as prescribed by doctors and monitor their responses to treatment.- Assist in patient assessments: You will assist in conducting patient assessments, gathering health histories, and collaborating with the healthcare team to develop and implement individualized care plans.- Maintain medical records: Keeping accurate and up-to-date medical records is crucial in providing optimal patient care, so you will be tasked with maintaining detailed records of all patient interactions.Required skills and expectations:- Diploma in General Nursing and Midwifery (GNM) is required.- 1-2 years of experience in a healthcare setting is preferred.- Strong communication skills and the ability to work well in a team environment.- Proficiency in basic nursing procedures and patient care techniques.- Ability to prioritize tasks and work efficiently in a fast-paced environment.

MAKING REIMBURSSMENT, MAKING IPD BILLING, MAKING CASHLESS PROCEDURE,PREAUTH TAKING, EMPANELMENT