Provider Contract Support
6 days ago
Role Purpose:
To manage contract administration, pricing, coding, extract data and network system maintenance by implementing agreed department action plans and rules to achieve system efficiencies.
Key Accountabilities:
1- Contract Administration;
- Implement the set contracts’ uniformity, standards and regulatory compliance with all providers.
- Coordinate the logistics of contracting new providers, new service codes and the renewal of contracts.
- Ensure that all providers’ files and system data are completed and updated in consistency with all agreements and amendments filing of contracts.
- Update systems and follow up the expiration dates of the contracts within the agreed timescales.
- Review providers’ coding and remove redundant and duplicate codes
- Monitor the expiration of regulatory licensing of the providers for timely renewals.
- Coordinate the implementation of addition /deletion of contracts/providers, amendments and significant contract milestone with the operating team and technical stakeholders.
2- Benchmark Support;
- Extract data necessary for benchmarking of services.
- Maintain updated master sheets for the benchmarks processes
- Conduct price comparisons with the market benchmarks when required
3- Pricing, Discounts and Coding’s;
- Identify redundant and duplicate codes to help the revamp of the coding system.
- Collect data statements of invalid service codes and billing above agreed prices for resolution
- Coordinate, internally and externally, for the resolution of coding and pricing default
- Upload the new prices, contracts and amendments in the operating systems.
- Review provider statements with new price amendments to ensure providers’ compliance.
- Identify and report system and statement errors to help with resolution.
4- Network Support;
- Ensure that network changes are updated in the systems
- Monitor providers, physicians and service finder for website support and development.
- Maintain updated master sheet for providers network distribution
**Skills**:
- Exposure in coding systems is a plus
- Experience in Healthcare insurance business is an advantage
- Good Computer skills
- Data analysis
**Education**:
Computer Science
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