Backend/ Operations Executive

Job Summary:

We are looking for a diligent and detail-oriented Backend/Operations Executive to join our team at Eye Mantra in Delhi. This role will primarily focus on TPA (Third Party Administration), empanelment, and other operational tasks to ensure smooth and efficient backend operations. The ideal candidate will have experience working with TPAs, empanelment procedures, and operational tasks within the healthcare industry, ensuring seamless coordination with insurance providers, hospitals, and patients.

Key Responsibilities:

TPA Management:

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

Empanelment:

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

Operational Support:

• Assist in the day-to-day backend operations of the hospital, ensuring efficient handling of all administrative tasks.
• 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 such as finance, patient care, and medical staff to ensure smooth operations and timely processing of patient-related documents.

Patient Documentation & Billing Support:

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

Compliance & Reporting:

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

Other Administrative Tasks:

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

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 will be an added advantage.

Experience:

• Minimum 2-4 years of experience in backend operations, particularly in TPA management, empanelment, and administrative support in a healthcare setting.
• Experience in handling patient insurance claims, empanelment processes, and hospital operations.
• Familiarity with healthcare billing systems and insurance claim processes.

Skills:

• Strong organizational and time-management skills, with the ability to handle multiple tasks efficiently.
• Good communication skills, both verbal and written, to interact with insurance companies, patients, and internal teams.
• Attention to detail and accuracy in documentation and claims processing.
• Knowledge of insurance protocols, empanelment, and hospital operations.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and healthcare management software.

Preferred Skills:

• Knowledge of healthcare billing systems and experience in the insurance industry (TPA).
• Familiarity with hospital software and document management systems.
• Experience with medical terminology and a strong understanding of healthcare regulations.