Provider Contract Support

Job Description

To accomplish contract administration, pricing & coding, extracting data and network system maintenance through the implementation of the agreed department action plans and rules to achieve system efficiencies within the agreed timescales.

Contract Administration:

• Implement the set contracts’ uniformity,standards and regulatory compliance with all providers.
• Coordinate the logestics 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 of the providers
• Monitor, regularly, the expiration of regulatory licensing of the providers to achieve timely renewals.

Benchmarking:

• Extract data necessary for benchmarking of services.
• Maintain updated master sheets for the benchmarks.
• Conduct price comparisons with the benchmarks whenever needed.

Pricing, Discounts and Codings:

• Identify redundant and duplicate code to help the revamp of the coding system.
• Collect, regularly, statements’ data 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 the first 3 statements of providers with new price amendmends to ensure providers’ compliance.
• Report, regularly, system and statement errors to the line manager.

Network Design and Management:

• 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

Volume Allocation:

• Extract referral data and reports to monitor the implementation of referral rules.

Coordination and Communications:

• Coordinate with the operating team and technical stakeholders to ensure the implementation of addition /deletion of contracts/providers, amendments and significant contract milestone

Skills

• 1-2 years in healthcare insurance business, data analysis and coding systems.

• Graduate of Paramedical or Allied Health Sciences (Preferrable)

• Coding systems

• Healthcare insurance business

• Computer skills

• Data analysis