Funder Relations Manager at Clinix Health Group (Pty) Ltd

JOB SUMMARY

• We are seeking a Senior Fund Relations Manager to lead and manage funder relations across the Group, ensuring strategic engagement with medical schemes and funders.
• The role is responsible for tariff negotiations, contracting, DSP status, quality reporting, and identifying new revenue opportunities. It serves as the key interface between CHG hospitals and external funders.

REQUIREMENTS

Minimum Qualifications

• Bachelor’s degree in clinical (Nursing or Medicine), or related field.
• Must have a post graduate qualification or MBA.

Minimum Experience

• 7 years’ experience in a Funder or Managed Healthcare environment

TECHNICAL SKILLS

• SQL Server (Advanced): T-SQL, CTEs, window functions, schema design, performance tuning.
• Funder relations
• Medical Coding
• Tariff negotiations
• Effective Report Writing and Communication
• Critical problem-solving ability
• Advanced computer literacy
• Strategic Stakeholder Management
• Negotiation skills
• Analytical skills
• Strategic thinking and decision-making

DELIVERABLES

• Strong relationship management and communication skills to build trust and maintain effective partnerships with medical schemes and claims representatives.
• Negotiation skills tailored for high-stakes healthcare environments, including understanding regulatory frameworks and tariff determination processes.
• Liaise with hospitals upon finalisation of contractual arrangements
• In collaboration with relevant parties from hospital facilities identify improvement and growth opportunities
• Escalate issues to Funders that relate to short-payments or non-compliance regarding agreed terms
• Ensure that tariff changes are reflected on SAP and that Case Managers receive confirmation upon change effect
• Develop proposals to the Funders based on the pricing mandate and with due consideration to funder variations
• Annually adjust tariff schedules according to contractual agreements and share with Group Finance for auditing
• Through IT, ensure the new tariffs are loaded on all relevant software
• Lead the identification of new Funders to assess ways in which the Group can optimise revenue opportunities
• Lead price negotiation with doctors and continuously assess success of product / service against revenue targets
• Manage stakeholder relationships and quality of service delivery to ensure successful overall business results
• Able to interpret key drivers of efficiency or inefficiency from Medical Scheme meetings and Cost Per Event reports and use these insights to engage relevant internal stakeholders for performance improvement.
• Identify and implement opportunities for cost reduction and to streamline processes
• Ensure good governance including the effective use of management systems to monitor compliance to business direction and policies
• Drive adherence to statutory standards, policies and procedures within the business unit to ensure compliance at all times and take remedial action where necessary
• Establish, implement, monitor and audit the key business processes and metrics