OVERALL JOB PURPOSE:
- The overall purpose is to ensure that the business relationship with existing, new and potential Medical Service Providers is as healthy as possible and that our clients are getting services as promised.
- The jobholder will be expected to demonstrate integrity, commitment and loyalty and perform all duties in accordance with the organization’s office routines and procedures, keeping in mind the overall business objectives with a keen eye on cost management and fraud mitigation.
- Ensure all providers on the BRITAM Panel have signed up contracts with BRITAM including agreed rates and discounts awarded i.e. all doctors, hospitals and support facilities.
- Compilation of BRITAM tariff guided rates for all services
- Renegotiation of terms with existing MSPs within set Britam tariffs Insurance guidelines; make recommendations for changing terms outside the job’s guidelines.
- Enroll new MSP as requested by clients in line with set entry criteria’
- Maintain and update all MSP prices and contact details on the provider panel list and ensure the list remains current.
- Quarterly posting of an updated MSP panel on Britam website.
- Attend/Plan planned quarterly MSP meetings as well as Impromptu meetings as well as prepare and submit minutes of all meetings.
- Carry out country wide service provider audits to ensure protocol is adhered to.
- Ensure all providers accredited have working smart readers and are operational.
- Submit monthly, quarterly and Provider Relationship reports.
- Ensure all Protocols and Processes in Provider management are documented and compiled in provider partnership manual/guide.
- Categorize providers as per class of service, cost etc. in line with enrollment for disease management.
- Plan and Conduct health talks
COMPETENCIES AND REQUIREMENTS
- The jobholder is responsible for maintaining constant contact with hospitals to ensure continuous well-being of all the stake-holders.
- Good interpersonal skills.
- Excellent clinical and analytical skills
- Well versed with managed care operations
- A proven ability to build strong client relationships and maintain an excellent customer focus.
- Good Negotiation skills
- Conversant with international standards on provider and healthcare management.
- Good presentation skills
QUALIFICATIONS AND WORK EXPERIENCE
- Nursing Degree or Diploma
- Two years’ previous experience in similar role or in managed care.
- Monitoring and Evaluation certification is an added advantage
- Computer literate.
KEY PERFORMANCE STANDARDS & AREAS
- Ensure smooth operations between the service provider and the business
- Ensure cost effective services are offered by negotiating for all services provided
- Discrediting of service providers in accordance to set guideline e.g in cases of Fraud
- Operational set guidelines are adhered to as.
Friday, February 24, 2017
Nursing Degree or Diploma
Two years’ previous experience in similar role or in managed care
Monitoring and Evaluation certification is an added advantage