Pr Contract Management

1 week ago

Al Hufūf, Eastern Province, Saudi Arabia Bupa Arabia Full time

Role Purpose:


To accomplish effective contract management and network design of the providers through the implementation of the agreed providers' strategy and framework while complying with CCHI & SAMA rules& regulations to deliver effective price & cost management and projects' savings.

In addition ,aligning with sales & marketing to continuously developing new products & services that support business development &proposition in the insurance market and achieve business profitability and expansion goals.


Key Accountabilities:
1- Contract Management;

  • Set up the contracts' rules and standards with all providers for the best interest of the business
  • 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.
2- Benchmarking;

  • 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.
3- Pricing, 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
4- 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.
5- Network Design and Management;

  • Ensure that the network of providers is comprehensive 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.
6- Volume Allocation;

  • Enhance stepladder referrals system with regular updates to achieve best practice and cost effectiveness.
  • Develop network of anchor providers and centres of excellence
  • Manage volume reallocation of all or specific services from one provider to another whenever indicated
7- Service Innovation;

  • Explore and develop new payment approaches to cope with business growth like paradigm shift, prepaid services, and accountable care organization.
  • Explore and develop partnership relations with strategic providers
  • Introduce healthcare plans that respond to market needs, health & benefits and business developments.
  • Develop new products and services, e.g. Fast track, external doctors, special arrangement (SPA), High skills physicians' network, maternity and uncovered services.
8- Coordination and Communications;

  • Ensure that addition/deletion of contracts/providers ,amendments and significant contract milestone are communicated to the operation team and technical stakeholders.
  • 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.
9- 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, necessary tools and support required to achieve the organizational development objectives
  • Build the capabilities of the team members.

Skills:

  • Familiarity with healthcare pricing and emerging models of care in the market.
  • Analytical mindset & Presentation skills.
  • Hospital management (preferrable)
  • Contracts & Prices negotiations.
  • Good knowledge of health insurance market regulations.
  • 2 years in medical practice would be an advantage.
  • Health Economics/Healthcare & Business Administration related studies would be an advantage.

Education:

Medicine and Surgery

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