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  • Posted: Apr 21, 2021
    Deadline: Not specified
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    Kaelo Engage is a content marketing agency specialising in creating socially responsible content. Whereas a traditional public relations agency may only focus on issuing press releases, we leverage our in-depth experience and team’s passion to profile your sustainability initiatives through meaningful and relevant content creation in print, digital, br...
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    Provider Relationship Specialist

    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

    Method of Application

    Interested and qualified? Go to Kaelo Engage on jobs.smartrecruiters.com to apply

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