19.09.2024
Provider Relationship Specialist
Kaelo
Johannesburg, GP, South Africa
Other High-Paying Jobs in Johannesburg
The Provider Relationship Specialist is responsible for the day to day management of the multi-disciplinary network. Ensuring that contractual obligations with medical schemes, insurance and primary care products are established and maintained. Maintaining strong relationships with DSP’s via periodic engagement and implementation of standards and to manage and maintain quality assurance checks. Query resolution and effective interaction management. Manage contracts and service level agreements, through effective reporting and administration.KEY OUTCOMES (not limited to) Level 4 and 5 process elementsManagement of Multi-disciplinary Network:Establish and maintain a Provider Network to serve patients in accordance with contractual obligations with medical schemes, insurance and primary care products.Ensure all required documentation is obtained from the provider prior to activating the contractTrain providers in keeping with Prime Cure services, policies and proceduresDevelop and implement sound administrative, communication and operational systems to ensure consistent service deliverySet work standards and ensure that these standards are metImplement quality assurance procedures within the provider networkResolve queries between funders, Prime Cure and service providers.Ensure all interactions with providers are documented and SOP’s are followedTraveling may be required to visit for elite and contravening practicesService level agreement management:Ensure that each service level agreement is adhered to and met by the relevant business unit ownerMonitor trends within the business that may adversely affect the SLA and ensure the line manager and relevant business unit owners are kept informedEnsure all queries are dealt within contracted SLA all stakeholder are kept informed of relevant progress work items or escalationsEnsure all provider details are kept up to date on MIP and provider listsReporting:Compile daily, monthly, quarterly and ad hoc reports with precision and quality and submit these internally and externally at the agreed deadline dates for providers allocated to youCollect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executiveComplete quality audits monthly on all network related SOP’sProvide reporting on engagement with providersUse of data to effectively identify and engage non-performing sites
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