Job Title: Provider Relations Specialist
Job Summary
The role holder will be responsible for service provider management, contracting, accreditation, and audits within the Heritage Insurance provider network.
Key Responsibilities
- Maintain a cordial working relationship with providers within the Heritage Insurance provider network.
- Accredit new service providers to meet the client’s needs and demands.
- Negotiate service fees upon contracting of new service providers, guided by Heritage Insurance rates and customary fees.
- Coordinate provider audits to ensure quality services are accessed by Heritage Insurance clients.
- Enforce compliance with Heritage rules and procedures regarding member access, policy exclusions, and panel rates.
- Coordinate with Underwriting/Actuarial departments and prepare monthly utilization reports on the performance of service providers; develop appropriate measures to contain costs.
- Ensure proper documentation of all service provider contracts and ensure timely renewal and KYC updates per set guidelines.
- Train service providers on Heritage Insurance service access procedures and processes; update them on any changes in terms of health products, existing processes, and other related claim policies.
- Engage service providers in negotiation for discounts and close finance reconciliations.
- Liaise internally with other sections to ensure resolution of service provider-related issues.
- Regularly update the Heritage Insurance provider panel and share timely updates with relevant stakeholders.
Qualifications
Bachelor’s degree or Diploma in Nursing, Clinical Medicine, Pharmacy, or a medically related discipline.
Experience
At least 3 years of experience in provider relations within medical insurance, a hospital, or a related industry.
Competencies
- Excellent communication and negotiation skills.
- Good analytical skills.
- Computer literate in MS Office and Excel applications.
- Good knowledge of provider dynamics and landscape.
- Cost optimization strategies – ability to implement cost-effective measures while maintaining service quality.
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Contact Information
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