Provider Relationship Specialist at Kaelo Engage

Job Description
The Provider Relationship Specialist is responsible for the 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 and implementation of standards and implement, manage and maintain quality assurance. Query resolution and effective interaction management. Manage contracts and service level agreements, through effective reporting and administration.

JOB DETAILS
BUSINESS UNIT: Operations - Networks

KEY OUTCOMES (not limited to) Level 4 and 5 process elements
Management 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 contract
• Train providers in keeping with Prime Cure services, policies and procedures
• Develop and implement sound administrative, communication and operational systems to ensure consistent service delivery
• Set work standards and ensure that these standards are met
• Implement quality assurance procedures within the provider network
• Resolve queries between funders, Prime Cure and service providers.
• Ensure all interactions with providers are documented and SOP’s are followed

Service level agreement management:

• Ensure that each service level agreement is adhered to and met by the relevant business unit owner
• Monitor trends within the business that may adversely affect the SLA and ensure the line manager and relevant business unit owners are kept informed
• Ensure all queries are dealt within contracted SLA
• Ensure all provider details are kept up to date on MIP and provider lists

Reporting:

• 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 you
• Collect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executive
• Complete quality audits monthly on all network related SOP’s

Qualifications
SPECIAL REQUIREMENTS

• Ability to maintain confidentiality, problem solve, negotiate and communicate 

PERSON DETAILS: WORK EXPERIENCE
REQUIRED

• At least 3 years’ experience in the Medical Scheme or Healthcare Administration industry in a client support or provider Management roll

PREFERRED

• Proven work experience as a client or provider Management role

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY
REQUIRED

• Grade 12 or equivalent NQF 4 certificate

PREFERRED

TECHNICAL SKILLS OR KNOWLEDGE
REQUIRED

• Computer Literacy – Microsoft Excel, Word and PowerPoint
• Strong phone, email (written) and inter-person communication skills

PREFERRED

• Knowledge of Medical Scheme Industry

Additional Information

•       Accountability
•       Action orientated
•       Communication
•       Business writing and presentation skills
•       Problem solving skills
•       Creative thinking         
•       Strong relationship skills
•       Growth and development mind-set     
•       Planning and organisation
•       Resilient and adaptive     
•       Systems thinking and connecting ability     
•       Professional and brand conscious