Provider Liaison Officer

2 weeks ago

East London, Eastern Cape, South Africa Tych Business Solutions Full time
The
Provider Liaison Officer will be required to provide support to the Manager: Provider Liaison Office through the implementation of the following
Key Performance Areas (KPAs):

  • Support the Manager: Provider Liaison Office in maintaining the client relationship with healthcare providers within the assigned region
  • Participate in the review and submission of client networks reports
  • Support the Manager: Provider Liaison Office in the management of the Managed Care Organisations that are contracted by the Scheme
  • Participate in the review of the providers efficiency reports
  • Provide substantiated commentary on the quality of network services and provider compliance to the Scheme network agreements
  • Represent the Healthcare Management Division at SPN and Stakeholder Engagements and promote network participation by healthcare providers
  • Provide substantiated commentary on the quality of network services and provider compliance with Scheme network agreements
  • Provide periodic reports relating all stakeholder engagements to the

Senior Manager:
Networks and Provider Relations

  • Ensure continuous education on client strategy, systems, processes, and product to the providers within the assigned region
  • Serve as a single point of contact for escalations related to claims and authorizations issues from the providers within the assigned region.
  • Perform a secretariat function for the provider relations engagements
  • Support other Scheme Division's in managed care activities
  • Fulfil various stakeholder engagements as directed by the Chief Healthcare Officer

Qualifications and other requirements are:

  • At least a 3year Diploma/Degree or equivalent NQF level 6 in Clinical Sciences related fields
  • At least 5 years of work experience in the healthcare funding/medical scheme industry
  • Must have experience in provider relations management
  • Experience in case/ claims management will be advantageous
  • Must have experience in the development and presentation of management reports
  • Computer literacy and MS Office skills
  • Sound Quantitative and qualitative analysis skills with ability to manage priorities
  • Have ability to work well as part of a team
  • Be responsible and reliable
  • Have diligent work ethics with attention to detail
  • Excellent communication and writing skills
  • Have sound planning/project management skills
  • Be a selfstarter
  • Own transport essential

Job Type:
Permanent

Experience:

- healthcare funding/medical scheme: 5 years (preferred)

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