Provider Relations Medical Operations

4 weeks ago

Jeddah, Saudi Arabia Bupa Arabia Full time

Role Purpose:
To be responsible for the commercial and medical management of the portfolio providers in order to resolve the identified trends ,unit cost control and obtain competitive commercial terms and reconciliation outcome within the agreed target forecasting ,timescales and quality standards.

Key Accountabilities:
1- Reconciliation of the accounts;
- Set the targets aligned with the overall forecast
- Review the statements of accounts and ensure it's quality before sending to the providers
- Analyze the statement with documentation including the achievable amounts
- Negotiate the reconciliation with the providers to achieve the set targets
- Document the reconciliation facts and send feedback to the claims department and regional manager
- Prepare presentation to the owners of top 20 provider ,at least once/year to highlight the trends and errors
- Ensure that the reconciliation is conducted on regular basis and in line with the CCHI regulations

2- Contract management;
- Review the existing and renewed contracts to identify and resolve issues that ensure better commercial terms and improve operation
- Agree with the providers on the prices of the new service codes to be aligned with the standard Bupa prices and/or the usual & customary prices
- Maximize the commercial benefit by bundling of services and achieve preferrable billing schedules

3- Better commercial terms;
- Set the targets aligned with the overall forecast
- Prepare the proposals for better prices and discount structures of the frequent services and package in coordination with the commercial team
- Negotiate and agree with the providers for better prices
- Intimate the agreements to the commercial and support team for uploading and implementation
- Negotiate better deals for the identified high value claims on real time basis before sending the claims
- Monitor the compliance of the providers with the agreements on their claims presentation

4- Communications and trends resolutions;
- Identify the unfavorable trends in medical practice of the providers
- Prepare presentations and conduct education sessions with the medical staff of the identified providers ,twice a year
- Communicate identified issues that improve the providers management to the claims ,relation team and commercial teams.
- Keep continuous relation with other medical team in the business including the hospitals audit doctors
- Attend to members and providers complaints on medical issues

**Skills**:

- Medical practice
- Claims adjudication
- 2 years in medical practice
- 2 years in claims adjudication

**Education**:
Bachelor of Medicine and Surgery

  • Provider Relations Medical Operations

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Bupa Arabia Full time

    Role Purpose:To be responsible for the commercial and medical management of the portfolio providers in order to resolve the identified trends ,unit cost control and obtain competitive commercial terms and reconciliation outcome within the agreed target forecasting ,timescales and quality standards.Key Accountabilities:1- Reconciliation of the accounts; Set...

  • Provider Medical Qc

    2 months ago

    Jeddah, Saudi Arabia Bupa Arabia Full time

    Building Quality Control Models that capture the required transactions in any given stream. - Perform the Quality Control Process: that includes, and not limited to, sampling, validation and releasing the related scorecards across all the functions under the scope of the Medical Quality (Preauthorization, Claims, Re-Imbursement and CS). - Perform all NPS...

  • Medical Claims Operations

    2 weeks ago

    Jeddah, Saudi Arabia Bupa Arabia Full time

    To ensure that assigned provider’s Inpatient and Outpatient claims are medically & commercially adjudicated within the specified timeframe and within the targeted quality to achieve the business objective of ensuring that BUPA delivers high quality claim statements. Adjudication - Process all the daily batches of claims assigned in line with medical...

  • Medical Claims Operations

    4 weeks ago

    Jeddah, Saudi Arabia Bupa Arabia Full time

    **Role Purpose** To be fully trained and aware of claims handling process including adjudication & fraud, waste and abuse management. Moreover, ensuring that daily assigned tasks are completed withing the specified time frame in line with Bupa’s values. **Key Accountabilities** - Process all the daily batches of claims assigned in line with medical...

  • Medical Claims Operations

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Bupa Arabia Full time

    Role PurposeTo be fully trained and aware of claims handling process including adjudication & fraud, waste and abuse management. Moreover, ensuring that daily assigned tasks are completed withing the specified time frame in line with Bupa's values.Key Accountabilities Process all the daily batches of claims assigned in line with medical policy and Outpatient...

  • Medical Coder

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Dr. Sulaiman AL Habib Medical Group Full time

    Degree in medical coding or related field.Deep knowledge of international medical coding systems (eg ICD-10, CPT).Ability to analyze and accurately code medical documents.Excellent communication skills.Ability to work effectively in changing medical environments.Adherence to legal and ethical standards in medical coding.

  • Medical Coder

    4 weeks ago

    Jeddah, Saudi Arabia Dr. Sulaiman AL Habib Medical Group Full time

    Degree in medical coding or related field.Deep knowledge of international medical coding systems (eg ICD-10, CPT).Ability to analyze and accurately code medical documents.Excellent communication skills.Ability to work effectively in changing medical environments.Adherence to legal and ethical standards in medical coding.

  • Medical Representative

    4 weeks ago

    Jeddah, Saudi Arabia Andalusia Group For Medical Services Full time

    We are looking for a persuasive medical representative to promote and sell Company services to doctors, clinics, and other relevant healthcare professionals. The medical representative’s responsibilities include persuading potential customers to purchase company medications, identifying prospective business opportunities for the company, and providing the...

  • Medical Representative

    2 weeks ago

    Jeddah, Saudi Arabia Andalusia Group For Medical Services Full time

    We are looking for a persuasive medical representative to promote and sell Company services to doctors, clinics, and other relevant healthcare professionals. The medical representative’s responsibilities include persuading potential customers to purchase company medications, identifying prospective business opportunities for the company, and providing the...

  • Medical Representative

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Andalusia Group For Medical Services Full time

    We are looking for a persuasive medical representative to promote and sell Company services to doctors, clinics, and other relevant healthcare professionals.The medical representative's responsibilities include persuading potential customers to purchase company medications, identifying prospective business opportunities for the company, and providing the...

  • Medical insurance specialist

    2 months ago

    Jeddah, Saudi Arabia Nahdi Medical Pharmacies Company Full time

    Powelson Consulting View our Job Board! We are a recruiting firm with a large variety of positions in many industries throughout all Our clients are currently only located in the United States of We currently DO NOT have C2C or VISA rolesSummaryPrimary Duties - We are like a mini version of We are like a hub that brings things in,...

  • Medical insurance specialist

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Nahdi Medical Pharmacies Company Full time

    Powelson Consulting View our Job Board We are a recruiting firm with a large variety of positions in many industries throughout all Our clients are currently only located in the United States of We currently DO NOT have C2C or VISA rolesSummaryPrimary Duties - We are like a mini version of We are like a hub that brings things in, scans the...

  • Medical insurance specialist

    4 weeks ago

    Jeddah, Saudi Arabia Nahdi Medical Pharmacies Company Full time

    Powelson Consulting View our Job Board! We are a recruiting firm with a large variety of positions in many industries throughout all Our clients are currently only located in the United States of We currently DO NOT have C2C or VISA rolesSummaryPrimary Duties - We are like a mini version of We are like a hub that brings things in,...

  • Medical coding specialist

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Dr. Sulaiman AL Habib Medical Group Full time

    Degree in medical coding or related field.Deep knowledge of international medical coding systems (eg ICD-10 and CPT).Ability to accurately analyze medical information.Excellent communication skills.Adherence to legal and ethical standards in medical coding.Ability to work effectively in a changing medical environment.

  • Medical coding specialist

    4 weeks ago

    Jeddah, Saudi Arabia Dr. Sulaiman AL Habib Medical Group Full time

    Degree in medical coding or related field.Deep knowledge of international medical coding systems (eg ICD-10 and CPT).Ability to accurately analyze medical information.Excellent communication skills.Adherence to legal and ethical standards in medical coding.Ability to work effectively in a changing medical environment.

  • Medical Sales Representative

    7 days ago

    Jeddah, Saudi Arabia Andalusia Group For Medical Services Full time

    One of the Biggest Hospitals in KSA, Jeddah is looking forward to Hire Medical Sales Representative. **Qualifications**: Medical Sales, Communication, and Customer Service skills Knowledge of Medicine and Pharmacy practices Excellent communication and presentation skills Ability to work independently and as part of a team Bachelor's degree in a related...

  • Medical Gas Instalation and Maintenance

    4 weeks ago

    Jeddah, Saudi Arabia Al Watad Medical Full time

    **City: - Jeddah - Saudi Arabia** **SUMMARY Work Description** Conducts variety of electronic, mechanical, and electromechanical tests on Medical Gas systems and sub-assemblies to ensure system functions according to HTM20. **ESSENTIAL DUTIES AND RESPONSIBILITIES** Other duties may be assigned. - Installs Medical Gas systems - Reads test schedule, work...

  • Medical records coordinator

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Dr. Sulaiman AL Habib Medical Group Full time

    Certification in medical records recording techniques or related field.Deep knowledge of medical regulations and standards.Ability to accurately manage and organize medical records.Excellent communication skills.Ability to work effectively in a changing medical environment.Commitment to confidentiality and professional ethics when dealing with sensitive...

  • Medical records auditor

    2 weeks ago

    Jeddah, Makkah Province, Saudi Arabia Dr. Sulaiman AL Habib Medical Group Full time

    Certification in medical records recording techniques or related field.Deep knowledge of medical regulations and standards.Ability to accurately analyze and evaluate medical records.Excellent communication skills.Ability to work effectively in changing medical environments.Commitment to confidentiality and professional ethics when dealing with sensitive...

  • Governmental Relations Manager

    4 weeks ago

    Jeddah, Saudi Arabia Group of medical services Full time

    A famous group for medical services is hiring "Governmental Relations Manager" in KSA, Jeddah. **Requirements**: - Previous Experience as "Governmental Relations Manager" at least 2 Years. - Must Be in Jeddah - High Communication Skills