Provider Management Executive at Total Health Trust Ltd

Job Description:

• To conduct hospital visit, inspection, accreditation, re-accreditation, education, claims audit, fraud detection, clinical audit, investigation of member’s related queries, resolve issues of short-payments as the need arise
• Implement provider management strategies for organizational growth, competitiveness and leadership
• To reconcile provider account received from the geographical regions assigned as well as any other delegated by the team lead.
• Organize and carry-out product, policies and processes training in-house for group of providers in assigned geographical areas.
• To negotiate with doctors and other health care providers about health care for clients
• Liaison with NHIS
• Represent organization in the health care events
• Update providers register under schemes and share updates with concerned departments
• Provide detailed provider management report
• Ensure that all critical areas that require improvement that contribute to the success of the strategy are identified and communicated to the team lead.
• Ensure prompt registration and processing of providers’ contracts on Medware.

Requirements:

• Candidate must be a registered nurse, midwife and possess B.Sc. Nursing
• Additional medical qualification will be an added advantage
• Candidate must have minimum of 5 years post-nursing qualification experience including 3 years in similar role in a Health Maintenance Organization (HMO).
• Candidate must have Clinical experience
• Candidate must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes.
• Excellent organizational, communication (verbal and written) skills and attention to detail

Other requirements:

• Good organizational and planning capabilities
• Innovative and quick thinking capabilities
• Innovativeness
• Adaptive
• Decision Making skills
• Integrity
• Negotiation Skill
• Adaptive, expertise, Result-Oriented, Relationship Skill
• Working with people
• Strategic
• Must be a good collaborator/Team player