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Corporate Care Associate – Provider Relations – (2100007Y)
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.
- 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