Provider Network Consultant
My client is a well-established primary healthcare provider in the South African market. Their mission is to offer primary healthcare insurance solutions to the vast majority of South Africans unable to afford medical scheme coverage. We are searching for a Provider Network Consultant in Cape Town who will be the liaison between our company and its current and future providers. The successful candidate will work with the team to maintain operational service commitments, as well as the organisation’s mission and values. The successful candidate will report to our Provider Networks Manager.
Qualifications:
- Matric
- FAIS Compliant
- Diploma
- Valid Drivers Licence
Skills an Experience:
- At least 3 years of experience in a similar role
- Sound understanding of the South African Health industry, options, benefits, etc.
- Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.
- Meeting targets and regulatory requirements.
- Must have experience in working with all provider types and understand the logic as to how providers’ administration systems work for claims to be submitted.
- Must have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issues.
- Excellent oral and written communication skills
- Computer literate – MS Office suite, i.e. Word and Excel a must.
- A good understanding of claims risk profiling.
- This position requires extensive travelling.
- Ability to travel to all providers.
Scope of responsiblity:
- Develop integrated networks with quality providers yielding a geographically competitive, broadly accessible, stable network that achieves company objectives.
- Evaluate practices in analysing member care, and trend quality compliance at the provider level.
- Develop action plans and programs to support provider practices in continuous quality improvement using approved guidelines.
- Responsible for provider education, contract compliance, and resolving provider concerns and issues
- Negotiate all Provider Network, casualty, and Hospital contracts on an individual basis and or in groups(IPA’s and discipline-specific groups) where appropriate. Partner with internal stakeholders to create a seamless experience for providers.
- Ensure all enquiries are resolved satisfactorily and customer requirements within business rules are met.
- Continuous risk management of all providers and take action in areas where costs are exuberant.
- Identify and resolve network access gaps or perceived gaps.
- Supply monthly management reports.
- Any other duties as assigned by the company from time to time
Interested candidates who meet the above criteria are requested to e-mail a detailed CV to ( [Email Address Removed] ) or to contact Gary on [Phone Number Removed];
Please view our website: LetsLink . co . za
By applying for this position and providing us with your CV and other personal information, you are consenting to the information being used for the specific purpose for which it was provided, which is recruitment purposes and possible appointment purposes (Should you be successful). Please note that your information will be processed for recruitment purposes only or for such purposes relating to assessing the establishment of the employment relationship with yourself, and this will be done in accordance with the applicable data protection and privacy legislation. We confirm that such information will not be used for any other purpose without your prior consent.
If your application is not successful, we retain your CV and other information provided for a period of 24 months after which it will be destroyed in a secure manner. If you object to your information being used in accordance with the aforementioned clauses, please indicate your objection and we will immediately destroy your personal information in a secure manner.
Desired Skills:
- Communcation skills
- Computer literate
- Claims risk profiling
Desired Work Experience:
- 2 to 5 years Systems / Network Administration
Desired Qualification Level:
- Diploma
About The Employer:
Private Company