Job Objective / Purpose:
The Provider Relations Officer is responsible for developing the network of hospitals, clinics, and doctors through contract negotiations, relationship development, and servicing. S/he will serve as a communication link between the hospitals/doctors and Flexicare (HMO).
This role will be hired under Health Delivery System, Inc. - a subsidiary of RelianceUnited.
Duties and Responsibilities:
- Network Development
- Develops the provider network by contracting hospitals / doctors requested or referred by members and the accounts management team.
- Negotiates with non-accredited doctors to accept Flexicare rate and eventually participate in Flexicare network.
- Responsible for New Hospital / Doctor Orientations and continued education of existing providers to ensure company programs, policies and procedures, and initiatives are effectively communicated and followed by the provider network.
- Network Management
- Conducts regular on-site visits to providers in order to address issues or areas of concern and tries to provide possible resolutions to ensure retention of accreditation and/or avoid suspension.
- Ensures that all in-network hospitals and doctors send their billings to Flexicare within 45 days from member’s treatment date.
- Maintains accurate database of the provider network.
- Proactively organize provider network engagement events (e.g. MD or Doctors' night).
Background and Qualifications:
- Graduate of a 4-Year course in any field
- At least 1 year of solid working experience in the related field and with a successful track record are required for this position
- With experience working in a hospital, TPA/HMO or insurance companies
- Excellent negotiation and account management skills
- Good communication (written and oral), interpersonal, problem-resolution and critical thinking skills
- Ability to develop strong provider relationship
- Proven ability to work independently and as a team member
- Ability to do on-site visits and work on weekends and extend beyond company operating hours when needed
Work Conditions:
- Permanent Position
- 8-hour work days, Monday through Friday
- To be assigned in Greenfield District, Mandaluyong City
- Occasional evening or weekend work may be required as job duties demand