Provider Liaison Administrator

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Provider Liaison Administrator

  • Post Date:April 25, 2022
  • Views 591
0 Applications
  • Career Level Other
    Qualification Diploma
    Experience 3-5 Years
  • Industry Health Care
Job Description

The Society wishes to invite applications from suitably qualified and experienced individuals to fill the position of Provider Liaison Administrator that has arisen in the Group.

Job Description

  • Profiles the Service Providers for enrolment onto the service provider network using analysed data and knowledge of Providers
  • Plans and organises engagement meetings with Service Providers to build relationships with them
  • Creates Cimas outposts with existing doctors and robust referral system within the Blue Zone network
  • Determines financial incentives and utilizes data and feedback to identify opportunities to improve the relationship between Cimas and Service Providers
  • Gathers medical industry information, interprets, and shares with internal contact for the benefit of the organization
  • Refers to the Provider Liaison Coordinator, Head Managed Care and Forensic Department identified cases of suspected fraud, waste, abuse and follows up the cases to finality
  • Supervises calculation and compilation of tariff schedules in line with medical aid tariff reviews and forwards to the Head Managed Care for quality control
  • Conducts research on alternative reimbursement models for medical aid cost containment and recommends to the Head Managed Care
  • Participates in Cimas weekly tariff committee meetings where discussions on innovative ways of handling tariffs to provide value are discussed
  • Monitors registration of service providers onto the Cimas System
  • Designs and reviews training materials for provider training workshops
  • Reviews provider claims to ensure compliance to claiming procedures
  • Arranges the accreditation of new institutions in line with Cimas standard operating procedures

Candidate Requirements

  • Diploma/Degree in General Nursing or any relevant Health Degree
  • Desirably a Post- Graduate qualification in Health Sciences
  • Valid Practicing Certificate as a Registered Health Practitioner
  • Experience in Healthcare Digital Systems Administration, Claims Handling and Knowledge of Healthcare Finance
  • Ability to manage and develop staff
  • Clear verbal and written communication and ability to prepare accurate reports
  • Ability to plan and organise in line with job requirements
  • Ability to interact, negotiate and achieve targets

If you are interested, apply no later than 26 April, 2022.