Backend/ Operations Executive

Job Summary:

Eye Mantra in Delhi is looking for a meticulous and detail-oriented Backend/Operations Executive to join our team. This position will focus on TPA (Third Party Administration), empanelment, and other operational responsibilities to ensure the smooth functioning of backend processes. The ideal candidate will have experience working with TPAs, managing empanelment procedures, and handling operational tasks within the healthcare sector, ensuring seamless coordination between insurance providers, hospitals, and patients.

Key Responsibilities:

TPA Management:

• Oversee the TPA process for patient claims, ensuring timely submission of documentation and resolving any insurance-related issues.
• Serve as the main point of contact between the hospital and TPA providers, coordinating all necessary steps for claim approval.
• Ensure the accurate and efficient processing of insurance claims, including pre-authorization, documentation, and follow-up.
• Verify patient eligibility for insurance coverage and resolve any discrepancies with insurance companies.

Empanelment:

• Manage the empanelment process with insurance companies, hospitals, and healthcare providers.
• Coordinate with insurance companies to complete all necessary paperwork for empanelment and revalidation.
• Keep up-to-date records of empaneled insurance providers, ensuring all agreements are current and active.
• Ensure compliance with the terms of empanelment and resolve any issues with insurance companies.

Operational Support:

• Assist in the daily backend operations of the hospital, ensuring that all administrative tasks are handled efficiently.
• Prepare, submit, and track documents related to patient billing, insurance claims, and empanelment.
• Maintain accurate records and databases for patient billing, insurance claims, empanelment, and related processes.
• Coordinate with departments like finance, patient care, and medical staff to ensure smooth operations and timely processing of documents.

Patient Documentation & Billing Support:

• Ensure accurate documentation of patient details, insurance information, and billing data.
• Assist in managing the billing process in collaboration with the accounts department to ensure accurate invoicing for services rendered.
• Track and follow up on pending claims to ensure timely settlements and reimbursements.

Compliance & Reporting:

• Ensure compliance with healthcare regulations and insurance protocols during claims and empanelment processes.
• Generate reports on claims, empanelment status, and operational performance for internal teams and management.
• Stay updated on insurance policies, procedures, and industry changes to ensure accurate handling of claims and empanelment tasks.

Other Administrative Tasks:

• Provide general administrative support, including filing, organizing documents, and preparing necessary paperwork.
• Assist senior management and other departments with any ad-hoc tasks as needed.

Requirements:

Education:

• Bachelor’s degree in a relevant field, preferably in Healthcare Administration, Management, or Business Administration.
• Certifications related to insurance, TPA operations, or hospital management are a plus.

Experience:

• 2 to 4 years of experience in backend operations, with a focus on TPA management, empanelment, and administrative support within a healthcare setting.
• Experience in managing patient insurance claims, empanelment processes, and hospital operations.
• Familiarity with healthcare billing systems and insurance claim processes.

Skills:

• Excellent organizational and time-management abilities, with the capacity to manage multiple tasks efficiently.
• Strong communication skills, both verbal and written, for interacting with insurance companies, patients, and internal teams.
• Meticulous attention to detail and accuracy in documentation and claims processing.
• In-depth knowledge of insurance protocols, empanelment processes, and hospital operations.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and healthcare management software.

Benefits:

• Knowledge of healthcare billing systems and experience working within the insurance industry, particularly with TPA.
• Familiarity with hospital software and document management systems.
• Experience with medical terminology and a solid understanding of healthcare regulations.