PR Contract Management

Job Description

To accomplish contract administration, pricing & cost effectiveness and network design of the providers through the implementation of the agreed department action plans to achieve quality, accessible and affordable healthcare within the agreed timescales

Contract Administration

• Implement the set of contracts’ uniformity and standards with all providers.

• Excute contracting new providers ,new service codes and the renewal of contracts in accordance with applicable guidelines and instructions

• Maintain contracts’ compliance with the regulatory, renewals and licensing requirements

• Follow up contracting administration to ensure timely processing and finalization

Benchmarking

• Engage in the Identifying of frequently billed items according to providers distribution

• Collect price range for each frequent item per network according to providers distribution

• Collect prices/quotations for other items/services whenever needed (experienced) or requested.

• Support other business units in pricing services and items

• Apply standard optical and dental pricing models.

• Implement the benchmarks and related guidelines in the providers’ agreements and pricing

Pricing ,Discounts and Codings

• Implement the revamped coding systems

• Resolve the defaults of the invalid & duplicate service codes and overbilling with the assigned providers

• Coordinate, internally and externally, for the resolution of coding and pricing defaults.

• Engage in business obligations of ICD 10-am implementation

• Ensure that new prices ,contracts and amendments are uploaded in the operating systems.

• Ensure the implementation of discounts ,PPD and volume discounts

Cost Effectiveness

• Identify items potential areas for price reductions to achieve business targets with the assigned providers

• Identify providers and services’ potential for bundling(in & out patients) and expansion of surgical packages

• Negotiating price reductions and bundling with the assigned providers

• Conduct studies for the financial impacts of proposal and agreements of new contracts/service codes and renewals

Network Design and management

• Identify areas for potential network redesign to achieve business objectives of affordable care.

Volume Allocation

• Monitor the implementation of stepladder and referral systems with regular updates to achieve best practice and cost effectiveness.

• Identify providers fitting network of anchors and centers of excellence

• Engage in building partner relationship with strategic providers

Coordination and Communications

• Coordinate with the operating team and technical stakeholders to ensure the implementation of addition /deletion of contracts/providers ,amendments and significant contract milestone .

• Coordinate with provider relation and stakeholders targets & plans of negotiation.

Skills

• Bachelor degree (in medicine is preferrable

• Post graduation training in business ,coding or insurance is preferrable

• Medical practice

• Hospital management

• Healthcare insurance business

• Computer skills and coding

• Data analysis

• 2 years in healthcare insurance business

• 2 years in data analysis

• 1 year in medical practice

• 1 year in hospital management is preferrable