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Medical Provider Relations

3 weeks ago

Riyadh, Saudi Arabia Bupa Arabia Full time

To manage the commercial and contractual relationship with Bupa network providers so as to ensure the compliance to regulations and the delivery of business benefits.
- Set the targets aligned with the overal forecast.
- Analyze, monitor the cost effectiveness of the unit and utilization of services of the providers to control and drop it year after year.
- Plan for reconciliation meetings, this will include scheduling meetings, coordination with medical manager, preparation of finacial figures and negotation tools
- 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
- Review and maitain the existing and renewed contracts to identify and resolve issues that ensure better commercial terms and improve operation
- Establish good relationship with new providers and assess the integration to Bupa network by comparing their prices to in network hospitals taking into consideration the providers’ location and the geographic distribution of the members
- Set the targets aligned with the overall forecast
- Improve the commercial trading terms by negotiating and signing up better prices and discounts to guarantee that Bupa will achieve the price reduction targets set on annual basis.
- Prepare the proposals for better prices and discount structures of the frequent services and package in coordination with the commecial team and medical manager
- 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
- Plan, coordinate and carry regular visits to the providers in order to maintain with them professional relationship.
- Follow up by phone and with written correspondences on issues raised during negotiation with providers.
- Identify the unfavourable trends in medical practice of the providers
- Manage the delivery of training session and development programmes to providers’ staff on Bupa new systems, policies and procedures.
- Keep continous relation with other medical team in the business including the hospital auditing doctors.
- Attend to members and providers complaints on medical issues

**Skills**:

- Providers Network Management
- Analytical, negotiation, planning and communication skills

**Education**:
Medicine & Surgery