Job Objective / Purpose:
The Provider Relations Supervisor is responsible for developing the network of hospitals, clinics and doctors through contract negotiations, relationship development, and servicing. S/he serves as a communication link between the hospitals/doctors and Flexicare (HMO).
The important part of the role is to maintain positive relationships between accredited network and doctors by regular onsite visits, facilitating provider education and providing resolutions to issues.
This role will be hired under Health Delivery System, Inc. (HDSI), Flexicare - a subsidiary of RelianceUnited.
Background and Qualifications:
- Educational Background
- Candidate must possess at least a Bachelor's/College Degree in any field. (Medically Inclined is a plus)
Training and Experience - At least 2 year(s) of solid working experience in the related field and with a successful track record required for this position.
- With experience working in a hospital, TPA / HMO or insurance companies.
- At least Level 2 Computer Skill Literacy (Basic Computing and Applications)
- Knowledgeable in PHIC, ICD, CPT, RUV computation
- Working Conditions/ Physical Requirements
- Ability to do on-site visits within Metro Manila and work on weekends and extend beyond company operating hours when needed.
- Advantageous Qualifications
- Excellent negotiation and account management skills
- Good communication (written and oral), interpersonal, problem resolution and critical thinking skills
- Ability to develop strong provider relationship
- Strong organizational, multi-tasking and time-management skills.
- Proven ability to work independently and as a team member
- Adheres consistently to the RCI values
- With previous work experience in HMO
- Knolwedgeable in Philhealth RVS
- Candidate must have no immediate plans or have pending plans of applying abroad for the next 4 years.
- Medically-skilled worker is a plus for this role
Duties and Responsibilities:
- Network Development
- Develops the provider network by contracting hospitals / doctors requested or referred by members and 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.
- Actively promotes the use of MedFlex® in hospitals
- Network Management
- Conducts regular on-site visits (thrice a per week) to providers in order to address issues/ areas of concern and tries to provide feasible resolutions to ensure retention of accreditation and/or avoid suspension.
- Ensures that all in-network hospitals and doctors send their billings to Flexicare within 60 days from member’s treatment date.
- Provides assistance in maintaining and encoding the correct database of the provider network.
- Provides regular EOD report to to Flexicare Medical Case Manager
- Proactively organize provider network engagement events (e.g MD night).
Ability to commute/relocate to:
- Greenfield District, Mandaluyong City: Reliably commute or planning to relocate before starting work (Required)
Visit the RelianceUnited Website here:
https://tinyurl.com/ysjsn7ps
Apply for other roles via RelianceUnited Careers:
https://tinyurl.com/446sye6j