Network Contracting Specialist

3 weeks ago


Sandton, South Africa HR Studio Ltd Full time

We are seeking a skilled Network Contracting Consultant to join our team at HR Studio Ltd. This role is ideal for individuals with a strong background in provider contracting, data administration, and network management.

The successful candidate will be responsible for negotiating fees and rates with out-of-network providers, ensuring cost-effective service delivery. They will also be responsible for accurately performing data entry and documentation related to the repricing of medical claims, communicating with providers through various channels, and overseeing the claims process to ensure timely and accurate adjudication.

We are looking for a candidate who can demonstrate the ability to influence stakeholders and achieve mutually agreeable outcomes. They should be able to communicate clearly and professionally with both internal and external customers, make well-informed decisions using available resources and sound judgment, and adapt to changes in the work environment.

Key Responsibilities:

  • Initiate contact with out-of-network provider offices and manage requests from a designated queue.
  • Negotiate fees and rates with out-of-network providers to ensure cost-effective service delivery.
  • Accurately perform data entry and documentation related to the repricing of medical claims.
  • Communicate with providers through various channels (e.g., phone, email, fax) and diligently record all interactions and progress.
  • Oversee the claims process to ensure timely and accurate adjudication.
  • Process out-of-network claims efficiently and in accordance with established guidelines.

Requirements:

  • Matric Diploma or equivalent.
  • 1 year of provider contracting, data or network administration experience preferably in a healthcare third party administrator setting or 2 years of claims processing or customer service experience in a medical/healthcare setting including knowledge of medical terminology.
  • Prior work in a production environment.
  • Ability to maintain confidentiality and exercise discretion in handling sensitive information.
  • Proficiency in Microsoft Office.

Working Hours: 2pm - 11pm



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