Provider Relations Executive

Job Summary

• The Provider Relations Executive will assist in managing relationships between healthcare providers and the Health Maintenance Organization (HMO).
• This role involves supporting the onboarding process, coordinating communication between providers and HMO teams, addressing provider inquiries, and helping resolve issues related to claims, billing, or care delivery.
• The Provider Relations Executive will work closely with the Provider Relations Manager to ensure that providers are well informed and supported in their interactions with the HMO.

Responsibilities
Provider Communication & Support:

• Serve as a point of contact for healthcare providers, answering inquiries and providing necessary support.
• Ensure providers are well-informed of HMO policies, procedures, and updates.
• Address and resolve issues raised by providers related to claims, billing, or service delivery.

Onboarding & Training:

• Assist in the onboarding process for new providers, ensuring they are familiar with HMO guidelines.
• Help coordinate and deliver educational materials or training sessions for providers on relevant HMO policies and procedures.

Claims & Billing Assistance:

• Provide support to providers in understanding and resolving claims and billing issues.
• Act as a liaison between the provider and claims department to ensure timely resolution of issues.

Performance Monitoring & Reporting:

• Monitor provider performance and assist in the gathering of feedback from providers regarding their experience with the HMO.
• Prepare reports on provider performance and satisfaction for management review.

Data Protection & Confidentiality:

• Uphold the highest standards of confidentiality in handling company-related information, ensuring compliance with data protection laws and internal policies.
• Adhere to the company’s information security guidelines, including proper storage, transmission, and disposal of sensitive materials.
• Promptly report any suspected data breaches or unauthorized access to the appropriate company authority.
• Participate in periodic data protection training to stay informed about evolving security risks and best practices.

General Assignment:

• Execute any other duties and tasks that may be designated or assigned by the Company.
• Participate in the knowledge sharing programme of the department and the company
• To provide supports to the Managing Director and Vice Chairman as may be required towards serving the Board, Management and staff.

KPIs and Performance Metrics

• Provider Support Efficiency: Timely resolution of provider inquiries and issues.
• Provider Satisfaction: Positive feedback from providers based on surveys and interactions.
• Claims Resolution: Percentage of claims and billing issues resolved to providers’ satisfaction.
• Onboarding Success: Successful completion of onboarding for new providers without delays.
• Performance Reporting Accuracy: Accuracy and timeliness of provider performance reports.

Qualification
Education:

• Bachelor’s Degree in Healthcare Administration, Business, or related field.

Experience:

• Minimum of 2 years of experience in provider relations, healthcare administration, or customer service within an HMO environment.

Skills and Competencies:

• Strong communication and interpersonal skills.
• Problem-solving abilities to handle provider issues effectively.
• Knowledge of healthcare billing and claims processes.
• Customer service-oriented mindset with a focus on provider satisfaction

Application Closing Date
Not Specified.

Method of Application
Interested and qualified candidates should:
Click here to apply online

Share this job: