MantraCare - Manager - TPA & Empanelment

Description:

Job Title: Manager TPA & Empanelment

Location: Eye Mantra Hospital - Paschim Vihar

Department: Administration

Job Summary:

- Drive empanelment with insurance companies, corporates, and government health schemes with a focus on ophthalmology packages (cataract, LASIK, retina, glaucoma, etc.).

- Oversee contract renewals, tariff negotiations, package updates, and ensure compliance with eye-carespecific empanelment terms.

- Build and maintain strong relationships with TPAs, insurance partners, corporate clients, and government health bodies.

- Prepare insurance-related MIS, package performance reports, and revenue insights for senior management.

- Handle escalations related to patients, insurance claims, approvals, pre-authorizations, and TPA processes.

- Coordinate with ophthalmology consultants, billing teams, and patient coordinators to ensure smooth insurance workflows.

- Stay updated with the latest insurance guidelines, Ayushman Bharat schemes, and policies relevant to eye care.

Qualifications & Experience:

- Bachelors or Masters degree in Healthcare Administration / Business Management or related fields.

-3+ years of experience in TPA operations or hospital empanelment specifically in an eye hospital or ophthalmology center (minimum 2 years in a managerial role).

- Strong understanding of ophthalmic procedures, coding, insurance packages, and claim documentation.

- Experience using hospital management software and insurance portals.

- Excellent communication, negotiation, and analytical skills.

Key Skills:

- Ophthalmology Insurance & TPA Knowledge

- Empanelment & Contract Negotiation

- Relationship & Stakeholder Management

- Compliance & Regulatory Knowledge

- Problem Solving & Conflict Resolution

- Eye-carespecific billing & documentation expertise