Job Description:• To conduct hospital visit, inspection, accreditation, re-accreditation, education, claims audit, fraud detection, clinical audit, investigation of member’s related queries, resolve issues of short-payments as the need arise• Implement provider management strategies for organizational growth, competitiveness and leadership• To reconcile provider account received from the geographical regions assigned as well as any other delegated by the team lead.• Organize and carry-out product, policies and processes training in-house for group of providers in assigned geographical areas.• To negotiate with doctors and other health care providers about health care for clients• Liaison with NHIS• Represent organization in the health care events• Update providers register under schemes and share updates with concerned departments• Provide detailed provider management report• Ensure that all critical areas that require improvement that contribute to the success of the strategy are identified and communicated to the team lead.• Ensure prompt registration and processing of providers’ contracts on Medware.Requirements:• Candidate must be a registered nurse, midwife and possess B.Sc. Nursing• Additional medical qualification will be an added advantage• Candidate must have minimum of 5 years post-nursing qualification experience including 3 years in similar role in a Health Maintenance Organization (HMO).• Candidate must have Clinical experience• Candidate must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes.• Excellent organizational, communication (verbal and written) skills and attention to detailOther requirements:• Good organizational and planning capabilities• Innovative and quick thinking capabilities• Innovativeness• Adaptive• Decision Making skills• Integrity• Negotiation Skill• Adaptive, expertise, Result-Oriented, Relationship Skill• Working with people• Strategic• Must be a good collaborator/Team player
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