TPA Manager

Job summary

Manage relationships with third-party administrators and oversee accurate, timely claims submission, approval, and payment processes. Coordinate with patients, providers, billing teams, and insurers to resolve issues, monitor performance, support staff, and ensure regulatory compliance.

Job details

Company Name: Eye-Q Eye Hospitals Job Title: TPA Manager Job Description: The TPA Manager will be responsible for managing the Third-Party Administrators (TPA) relations and ensuring smooth processing of patient claims. The role involves overseeing the daily operations related to TPA functionalities and ensuring compliance with established policies and procedures. The TPA Manager will collaborate closely with insurance providers, healthcare providers, and internal departments to streamline claim processes, resolve issues, and enhance operational efficiencies. Key Responsibilities: - Establish and maintain relationships with TPA organizations to facilitate claim processing and payment. - Oversee the claims submission and approval processes, ensuring timely and accurate processing. - Coordinate with the billing department to address any discrepancies and ensure correct claim submissions. - Monitor and analyze claims data to identify trends and areas for improvement. - Provide training and support to staff regarding TPA-related processes and practices. - Ensure compliance with applicable regulations and standards in TPA operations. - Act as a liaison between patients, healthcare providers, and TPAs to resolve claims-related issues. - Prepare regular reports on TPA performance and claim status for management review. Skills and Tools Required: - Strong knowledge of medical billing and coding, particularly in relation to TPA processes. - Excellent communication and interpersonal skills for effective relationships with internal and external stakeholders. - Proficiency in healthcare management software and Electronic Health Records (EHR) systems. - Strong analytical skills to assess claim data and identify trends. - Attention to detail to ensure accuracy in claims processing and documentation. - Problem-solving abilities to resolve claims-related issues efficiently. - Familiarity with healthcare regulations and compliance standards related to TPAs. - Ability to work in a fast-paced environment and manage multiple tasks simultaneously. Preferred Qualifications: - Bachelor’s degree in Healthcare Administration, Business Administration, or a related field. - Previous experience in TPA management or a similar role within the healthcare industry. - Knowledge of relevant healthcare laws and guidelines.

What you’ll do

Manage relationships with third-party administrators and oversee accurate, timely claims submission, approval, and payment processes. Coordinate with patients, providers, billing teams, and insurers to resolve issues, monitor performance, support staff, and ensure regulatory compliance.

Requirements

A bachelor’s degree in Healthcare Administration, Business Administration, or a related field is preferred, along with previous TPA management or similar healthcare experience. Candidates should have knowledge of medical billing and coding, healthcare regulations, and TPA processes, as well as strong communication, analytical, organizational, and problem-solving skills.

Listed skills

• Compliance · Preferred
• Data analysis · Preferred
• Communication · Preferred
• Attention to detail · Preferred
• Problem solving · Preferred
• Reporting · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Medical Billing
• Medical Coding
• TPA Management
• Claims Processing
• Healthcare Regulations
• Compliance
• Healthcare Management Software
• Electronic Health Records
• Data Analysis
• Communication
• Stakeholder Relations
• Attention To Detail
• Problem-Solving
• Staff Training
• Reporting

Job areas

• Healthcare
• Management & Leadership
• Finance & Accounting
• Data & Analytics