Provider Planning, Monitoring and Access Coordinator at Hamilton Lloyd and Associates

Job Summary

• To ensure robust provider relationship management, optimal satisfaction of all clients through excellent service delivery and ensure all stakeholders receive great customer service

Main Responsibilities

• Develop and execute strategic plan to acquire and manage HMO providers across the regions.
• Provide thorough assessment and credentialing of provider facilities.
• Ensure prompt attention and resolution to provider issues.
• Documentation of all formal provider complaints and issues with resolution plan and implementation dates.
• Drive required expansion of provider network within the regions.
• Organize and conduct provider forum annually
• Maintain an updated provider directory.
• Identify providers for member specific health needs.
• Ensure prompt investigation/resolution of complaints against providers from clients
• Conduct frequent and timely provider education for the providers on the health plans
• Ensure effective case management/referral of enrollees on admission.
• Verify and give approvals to enrollee requests from providers.
• Maintain records of all approvals given to providers with the relevant details.
• Conduct timely provider's activities as stated in the cycle (payment reconciliation, utilization reviews and hospital reassessments).
• Retrieval, update and record-keeping of all provider credentials and correspondence.
• Conduct tariff negotiations for provider services.
• Monitor provider network to ensure quality assurance.
• Ensure providers have sufficient supply of NHA documentation material (encounter, referral forms etc).
• Resolve all problems related to medical claims eligibility or benefits
• Resolve issues before claims payment to avoid re-adjunction
• Maintain high level of professionalism and competence in every enrollee/provider interaction.
• Build positive and productive relationships with enrollees.
• Make frequent client calls and visits to strengthen enrollee relationships.
• Analyze and resolve service issues promptly.
• Inform management about complex enrollee issues and resolutions.
• Develop process improvements to enhance service efficiency and effectiveness.
• Provide support in new product development and enhancement activities.
• Develop open and effective channels of communication with each enrollee that can be employed by other departments as well
• Work directly with enrollees to effectively manage their needs and preferences
• Develop and foster growth within existing clientele
• Frequently check-in with clients to confirm their satisfaction of services provided
• Exhibit expert knowledge regarding the products and services offered
• Work according to set standards and operating procedures
• Ensure effective and prompt enrolment of members
• Ensure quality assurance of HMO services to enrollees
• Follow up on approvals to enrollee requests from clients
• Ensure proper onboarding and induction of new members
• Build and maintain relationships with clients and key personnel within client’s companies
• Assist to organize physical health forum and enlightenment program chart and timetable for enrollees.
• Provide accurate and timely information on benefits and services available to members.
• Ensure completion of client management cycle effectively.
• Conduct business reviews to ensure enrollees are satisfied with the service rendered
• Monitor company performance against service level agreement and flag potential issues
• Liaise with internal departments to ensure enrollee needs are fulfilled effectively
• Carry out post-induction survey, client satisfaction survey and reviews
• Coordinate client-focused internal projects and determine the best utilization of resources to increase customer satisfaction
• Assist to develop, plan and execute of effective call center operations for NHA
• Ensure that calls and emails are answered within agreed time scales and in line with the company’s SOP.
• Recommend process improvements.
• Meet performance targets for speed, efficiency and quality;
• Ensuring all relevant communications, records and data are updated and recorded;
• Maintaining up-to-date knowledge of industry
• Ensuring that a high level of customer service and support is provided to all internal and external customers
• Perform any other duty as required by management.

Minimum Education

• Bachelor of Medicine, Bachelor of Surgery Degree (MBBS, MBChB, BMBCh or MD)
• Fellowship/membership must be registered with the Medical and Dental Council of Nigeria (MDCN)
• Current Full Registration with a National Medical Licensing body e.g. Nigerian Medical & Dental Council (MDCN); General Medical Council (GMC), etc.

Experience:

• Minimum of 10 years' experience post NYSC
• Minimum of 5 years cognate experience in relevant and related field

Key Skills and Competencies:

• Good Leadership and Management experience
• Experience working in a multicultural environment with diverse patient population would be an advantage
• Excellent client-facing and internal communication skills
• Excellent written and verbal communication skill
• Superior patient/customer service, ethics, and manners
• Excellent critical thinking, deductive reasoning and decision making skills.
• Good computer skills
• Relationship Management