Provider Relations Specialist at AfroCentric Group

Provider Relations Specialist 

AfroCentric Group is looking for a Senior Specialist: Provider Networks to effectively manage and own the operational relationship with the Specialist Societies (including Pharmacy groups) and to ensure full operational implementation and management

Responsibilities and Duties

• Communication of strategy implementation thereof
• Implementation of the engagement strategy
• Training Internal and External stakeholders
• Cost coverage as per network plan
• Geographic coverage as per network plan
• General and Ad hoc Communication to Specialists, Pharmacies and other disciplines as required
• Engagement with Specialists and Specialist leadership bodies
• Clinical Committee engagements
• Year end maintenance and communication
• Establishing customer satisfaction where indicated
• Improve efficiencies
• Compliance management
• Specialist Network Operational Efficiencies: Documentation of Business Processes
• Specialist Network Operational Efficiencies: Implementation and rollout of new Specialist Network models, initiatives and projects
• Provide oversight to the Provider Liaison Consultants and Network Contract Management Teams
• Ensuring Scheme SLAs are adhered to
• Provide clinical inputs on ex-gratia funding requests
• Open, review and resolve all clinical queries and assessments through providing a clinical decision or requesting more information where required
• Implement practical solutions that use the specialist and departmental systems and processes
• Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation
• Identify problems and develop and propose solutions to present to appropriate leader or stakeholders
• Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation
• Continuously review cost / benefit and Return on Investment within area of specialisation
• Engage with providers and pre-authorisation agents to build informed and supportive mutual relationships
• Maintain a high level of impact on other departments to support improved delivery
• Continually increase understanding of client and stakeholder needs, satisfaction and service delivery
• Assess all high risk or high cost medical procedures to ensure appropriate authorisation and claiming is facilitated
• Provide clinical training / support to identified stakeholders
• Provide medical advisory services to relevant parties
• Ensure that adequate knowledge regarding specialisation is shared as required and maintained within the research library
• Provide advice and / or training as required
• Maintain, develop and implement specialist knowledge within the day to day operations of the organisation
• Be a member of related professional bodies
• Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation
• Engage with and provide support to the established network of internal and external expert resources and partners provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when required
• Conform to project management disciplines when participating in projects
• Represent department or project on appropriate committees related to area of specialisation

Competencies

• Change Management
• Innovates
• Financial Acumen
• Computer Technology Skills
• Strong written and verbal Communication Skills
• Excellent Business Writing Skills
• Attention to Accuracy and Detail
• Numerical Ability
• Problem Solving
• Customer Focus

Experience

• Minimum 8 years managerial experience in the Healthcare industry having established relationships with Specialist Societies and Leadership
• Knowledge and application of relevant legislation
• Knowledge and application of dispensing of meds, surgical material & procedures
• Knowledge of scheme rules and contractual negotiations
• Knowledge and application of clinical principles and processes
• Ability to provide appropriate medical direction and advisory services

Qualifications

• Relevant Clinical Qualification