Insurance Relationship Associate
Skills
About This Role
Overview
- Insurance Empanelment and Contract Coordination
- Coordinates empanelment activities with insurance companies and TPAs for new facilities, services, and network expansions under the guidance of the Director – RCM.
- Assists in the preparation, coordination, and follow-up of contractual agreements with insurance companies and TPAs in line with approved terms.
- Ensures timely follow-up with insurers on empanelment status, contractual clarifications, and network confirmations.
- Coordinates with internal stakeholders to ensure agreed insurance terms and formalities are implemented accurately to minimize objections and delays.
Contract Administration and Documentation
- Maintains accurate, complete, and up-to-date records of all insurance contracts, agreements, and network documentation.
- Files and centrally documents insurance contracts and agreements with Finance while maintaining working copies for the RCM team.
- Tracks contract validity, amendments, renewals, and updates, escalating discrepancies or gaps as required.
- Ensures timely communication of contract-related updates to relevant stakeholders for correct operational implementation.
System Setup and Network Updates
- Coordinates with Finance and Billing teams to create and activate new Accounts Receivable (AR) accounts related to newly empaneled insurers or services.
- Supports insurance network and system updates in alignment with approved contract terms and payer requirements.
- Assists in validating that system configurations accurately reflect agreed insurance arrangements.
Policy Support, Training and Communication
- Prepares training and reference materials related to insurance products, eligibility rules, and network updates for Patient Relations and related teams.
- Supports periodic training and briefings to ensure operational teams understand insurance requirements and updates.
- Acts as a coordination point to ensure consistent interpretation and application of insurance policies across departments.
Operational Support and Compliance
- Applies functional and business knowledge of insurance operations to support compliance with insurer requirements and hospital policies.
- Prioritizes tasks effectively to meet departmental timelines and operational needs.
- Identifies and analyzes issues related to insurance coordination, supports resolution, and escalates when necessary.
- Ensures adherence to hospital and departmental policies, procedures, and documentation standards at all times.
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