Job Purpose and Key responsibilities
Reporting to the Team Leader Corporate Care, the role holder will provide guidance on all matters relating to cost management, provider on-boarding, provider relationship and provider audit process.
Key responsibilities
Supervise relationship management with providers to ensure providers are satisfied with the company.
Analysis of customer feedback surveys, provider complaints and compliments to inform decision making in provider experience.
Strategic cost control engagements with providers and monitoring adherence to service level agreements.
Price guided tariffs- building of provider pricelists especially for bigger providers on average pharmaceutical expenditure.
Monitoring Average Costs of providers and engaging high-cost providers to reduce unnecessary expenditure.
Supervision of provider audits to ensure that quality, cost effective medical services.
Supervision of the contracting process and ensure that all providers have active and updated contracts.
Ensure compliance with to any regulatory or health sector changes, such as billing and payment requirements.
Any other duties assigned by the Team Leader Corporate Care division.
Key Performance Measures
Saving the company money from wastage and exorbitant fees by providers.
Medical fraud mitigation
System support and integration on CPT coding
Knowledge, experience and qualifications required
Diploma, Degree in Nursing or Diploma in clinical Medicine or Diploma in Pharmacy
Moderate understanding of Insurance concepts
Professional qualification in FLMI,ACII and IIK
3-5 years’ experience in provider management
Apply via :
britam.taleo.net
