Provider Network Consultant

2 weeks ago

Cape Town, Western Cape, South Africa LetsLink Pty Ltd Full time
Provider Network Consultant

Qualifications:

  • Matric
  • FAIS Compliant
  • Diploma
  • Valid Drivers License

Skills an Experience:

  • At least 3 years of experience in a similar role
  • Sound understanding of the South African Health industry, options, benefits, etc.
  • Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.
  • Meeting targets and regulatory requirements.
  • Must have experience in working with all provider types and understand the logic as to how providers' administration systems work for claims to be submitted.
  • Must have a working knowledge of behavioral health provider business operations and analytical abilities to resolve provider issues.
  • Excellent oral and written communication skills


 Computer literate
  • MS Office suite, i.e. Word and Excel a must.
  • A good understanding of claims risk profiling.
  • This position requires extensive travelling.
  • Ability to travel to all providers.

Scope of responsibility:

  • Develop integrated networks with quality providers yielding a geographically competitive, broadly accessible, stable network that achieves company objectives.
  • Evaluate practices in analyzing member care, and trend quality compliance at the provider level.
  • Develop action plans and programs to support provider practices in continuous quality improvement using approved guidelines.
  • Responsible for provider education, contract compliance, and resolving provider concerns and issues
  • Negotiate all Provider Network, casualty, and Hospital contracts on an individual basis and or in groups(IPA's and disciplinespecific groups) where appropriate. Partner with internal stakeholders to create a seamless experience for providers.
  • Ensure all enquiries are resolved satisfactorily and customer requirements within business rules are met.
  • Continuous risk management of all providers and take action in areas where costs are exuberant.
  • Identify and resolve network access gaps or perceived gaps.
  • Supply monthly management reports.
  • Any other duties as assigned by the company from time to time

Please view our website:
LetsLink. co. za

Job Types:
Full-time, Permanent

Ability to Commute:

  • Cape Town, Western Cape (required)

Ability to Relocate:

  • Cape Town,

Western Cape:
Relocate before starting work (required)

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