Set up the contracts rules and standards with all providers for the best interest of the busines
Supervise contracting (and engage whenever necessary)new providers ,new service codes and the renewal of contracts.
Ensuring contracts compliance with the regulatory, renewals and licensing requirements.
New Providers facility field visit, evaluation & scoring.
Pricing , Benchmarking, Discounts and Coding:
Revamp the coding system and ensure cleaning up redundancy and duplication.
Ensure the resolution of defaults of the invalid & duplicate service codes and overbilling.
Develop standard discount structure, PPD rules and slabs of volume discount
Introduce systems for comprehensive benchmarks for frequently billed items (regional and per network)
Develop process, reference and guidelines for items that are not benchmarked to ensure that any item can be reasonably and fairly priced whenever requested by members or other business units.
Develop pricing models, guidelines & benchmarks for optical and other unique services.
Cost Effectiveness:
Develop (and negotiate whenever necessary) price reduction plans to achieve business goals.
Develop and enhance plans to agree with the providers on services bundling (in & outpatients) and expansion of surgical packages.
Ensure (and negotiate whenever necessary) that the prices of new & renewed contracts and addition of new services are consistent with the benchmarks and achieving the business targets.
Provide business stakeholders with price forecasting on regular basis and whenever necessary
Network Design and Volume Allocation Management:
Ensure that the network of providers is comperhensive and covering all benefits for each class.
Enhance , regularly ,the providers network (down/up grading) based on risk cost and business requirements
Optimize accessible and affordable network .
Practice type network management.
Enhance stepladder referrals system with regular updates to achieve best practice and cost effectiveness.
Develop network of anchor providers and centers of excellence
Manage volume re-allocation of all or specific services from one provider to another whenever indicated
Coordination and Communications:
Ensure that addition/deletion of contracts/providers ,amendments and significant contract milestone are communicated to the operation team and technical stalkeholders.
Communicate regular price forecast to the commercial finance
Communicate network redesign ,referral system updates to operation team and sales.
Coordinate with sales ,marketing and commercial finance volume re allocation ,healthcare plans and network updates
People Management:
Provide leadership ,professional guidance and directions to the assigned team members.
Preparing and overseeing KPI for the team.
Ensure and facilitate goal setting ;manage and constantly review individual performance
Provide regular feedback ,coaching ,and development
Motivate ,empower and enable direct reports by providing technical expertise , necessry tools and support required to achieve the organizational development objectives
Build the capabilities of the team members.
Skills
8+ Years
Analytical mindset & Presentation skills
Hospital management (preferrable)
Contracts & Prices negotiations.
Familiarity with healthcare pricing and emerging models of care in the market.
Bachelor of Medicine and surgery
Good knowledge of health insurance market regulations.
2 years in hospital management (preferrable)
2 years in healthcare insurance business
2 years experience in contracting and pricing of both providers and insurance
2 years in medical practice would be an advantage.
Health Economics/Healthcare & Business Administration related studies would be an advantage.
