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 detail
Other 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
To apply for this position, visit Total Health Trust Limited Career Page
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