We need a PR Contracts Management
Job Description
Contract Mangement:
- Set up the contracts’ rules and standards with all providers for the best interest of the busines
- Supervise contracting (and engage whenever necessary)new providers ,new service codes and the renewal of contracts.
- Ensuring contracts’ compliance with the regulatory, renewals and licensing requirements.
- New Providers facility field visit, evaluation & scoring.
Pricing , Benchmarking, Discounts and Coding:
- Revamp the coding system and ensure cleaning up redundancy and duplication.
- Ensure the resolution of defaults of the invalid & duplicate service codes and overbilling.
- Develop standard discount structure, PPD rules and slabs of volume discount
- Introduce systems for comprehensive benchmarks for frequently billed items (regional and per network)
- Develop process, reference and guidelines for items that are not benchmarked to ensure that any item can be reasonably and fairly priced whenever requested by members or other business units.
- Develop pricing models, guidelines & benchmarks for optical and other unique services.
Cost Effectiveness:
- Develop (and negotiate whenever necessary) price reduction plans to achieve business goals.
- Develop and enhance plans to agree with the providers on services’ bundling (in & outpatients) and expansion of surgical packages.
- Ensure (and negotiate whenever necessary) that the prices of new & renewed contracts and addition of new services are consistent with the benchmarks and achieving the business targets.
- Provide business stakeholders with price forecasting on regular basis and whenever necessary
Network Design and Volume Allocation Management:
- Ensure that the network of providers is comperhensive and covering all benefits for each class.
- Enhance , regularly ,the providers network (down/up grading) based on risk cost and business requirements
- Optimize accessible and affordable network .
- Practice type network management.
- Enhance stepladder referrals system with regular updates to achieve best practice and cost effectiveness.
- Develop network of anchor providers and centers of excellence
- Manage volume re-allocation of all or specific services from one provider to another whenever indicated
Coordination and Communications:
- Ensure that addition/deletion of contracts/providers ,amendments and significant contract milestone are communicated to the operation team and technical stalkeholders.
- Communicate regular price forecast to the commercial finance
- Communicate network redesign ,referral system updates to operation team and sales.
- Coordinate with sales ,marketing and commercial finance volume re allocation ,healthcare plans and network updates
People Management:
- Provide leadership ,professional guidance and directions to the assigned team members.
- Preparing and overseeing KPI for the team.
- Ensure and facilitate goal setting ;manage and constantly review individual performance
- Provide regular feedback ,coaching ,and development
- Motivate ,empower and enable direct reports by providing technical expertise , necessry tools and support required to achieve the organizational development objectives
- Build the capabilities of the team members.
Skills
- 8+ Years
- Analytical mindset & Presentation skills
- Hospital management (preferrable)
- Contracts & Prices negotiations.
- Familiarity with healthcare pricing and emerging models of care in the market.
- Bachelor of Medicine and surgery
- Good knowledge of health insurance market regulations.
- 2 years in hospital management (preferrable)
- 2 years in healthcare insurance business
- 2 years experience in contracting and pricing of both providers and insurance
- 2 years in medical practice would be an advantage.
- Health Economics/Healthcare & Business Administration related studies would be an advantage.
DETAILS TO REGISTER FOR THIS JOB:
Send your updated ATS-compliant CV:https://careers.bupa.com.sa/en/saudi-arabia/jobs/senior-executive-manager-pr-contracts-management-1100080689/
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