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Job Description
This role is related to maintaining relationships with Hospitals / Clinics / Pharmacies/TPAs.
- Identify sub-categories of providers and preferred providers through Provider Profiling analysis, to create distinctive network advantages for the company.
- Negotiate contracting and re - contracting process with health care service providers within corporate guidelines to ensure all services provided are cost effective and in accord to quality standards
- Conduct presentations and trainings for appointed health care provider staff on managed care concepts and provide updates on all related procedures in order to ensure awareness of company service requirements and policies across the network
- Review policy manual and network agreements in an on-going basis and provide suitable recommendations
- Support the Team leader / Manager in implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases
- Develop and maintain monthly statistical reports to facilitate benchmarking and performance management of network operations for management decision making
- Update company with data relating to addresses, discounts, creation of new codes, specialty, etc on a periodic basis
- Prepare quarterly network newsletters intended for Insured members, Insurance companies and Intermediaries
Job Requirements
- Diploma or Bachelors Degree in Medicine, or Pharmacy.
- 2-3 years of experience in a Provider Contracting role in TPA / medical insurance sector.
- Good interpersonal skills and ability to communicate clearly and effectively with internal and external clients across all levels, with fluency in business English (written and spoken) and Arabic.
- Driving License and car is advantage.
- Industry knowledge related to local healthcare services system will be an added advantage.
