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Job description:

Job Summary

As 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 patients

Key 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 hospitals revenue goals.

2. Reimbursement Management (Patient Support):

Proactive Documentation: Since we are "Non-Cashless," you will take full ownership of the patients reimbursement file. This includes:
Ensuring theDischarge Summary is clinically detailed to prevent insurer queries.
Compiling all original reports
Correctly filling outPart-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 patients 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: 35 years specifically inTPA Empanelment andInsurance 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 inTelugu 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):

Insurance Coordinator