PR Contracts Management.

Job Description

Contract Mangement

• Set up the contracts’ rules and standards with all providers for the best interest of the busines

• Supervise contracting (and engage whenever necessary)new providers ,new service codes and the renewal of contracts.

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

• New Providers facility field visit, evaluation & scoring.

Pricing , Benchmarking, Discounts and Coding

• Revamp the coding system and ensure cleaning up redundancy and duplication.

• Ensure the resolution of defaults of the invalid & duplicate service codes and overbilling.

• Develop standard discount structure, PPD rules and slabs of volume discount

• Introduce systems for comprehensive benchmarks for frequently billed items (regional and per network)

• Develop process, reference and guidelines for items that are not benchmarked to ensure that any item can be reasonably and fairly priced whenever requested by members or other business units.

• Develop pricing models, guidelines & benchmarks for optical and other unique services.

Cost Effectiveness

• Develop (and negotiate whenever necessary) price reduction plans to achieve business goals.

• Develop and enhance plans to agree with the providers on services’ bundling (in & outpatients) and expansion of surgical packages.

• Ensure (and negotiate whenever necessary) that the prices of new & renewed contracts and addition of new services are consistent with the benchmarks and achieving the business targets.

• Provide business stakeholders with price forecasting on regular basis and whenever necessary

Network Design and Volume Allocation Management:

• Ensure that the network of providers is comperhensive and covering all benefits for each class.

• Enhance , regularly ,the providers network (down/up grading) based on risk cost and business requirements

• Optimize accessible and affordable network .

• Practice type network management.

• Enhance stepladder referrals system with regular updates to achieve best practice and cost effectiveness.

• Develop network of anchor providers and centers of excellence

• Manage volume re-allocation of all or specific services from one provider to another whenever indicated

Coordination and Communications

• Ensure that addition/deletion of contracts/providers ,amendments and significant contract milestone are communicated to the operation team and technical stalkeholders.

• Communicate regular price forecast to the commercial finance

• Communicate network redesign ,referral system updates to operation team and sales.

• Coordinate with sales ,marketing and commercial finance volume re allocation ,healthcare plans and network updates

People Management

• Provide leadership ,professional guidance and directions to the assigned team members.

• Preparing and overseeing KPI for the team.

• Ensure and facilitate goal setting ;manage and constantly review individual performance

• Provide regular feedback ,coaching ,and development

• Motivate ,empower and enable direct reports by providing technical expertise , necessry tools and support required to achieve the organizational development objectives

• Build the capabilities of the team members.

Skills

• 8+ Years

• Analytical mindset & Presentation skills

• Hospital management (preferrable)

• Contracts & Prices negotiations.

• Familiarity with healthcare pricing and emerging models of care in the market.

• Bachelor of Medicine and surgery

• Good knowledge of health insurance market regulations.

• 2 years in hospital management (preferrable)

• 2 years in healthcare insurance business

• 2 years experience in contracting and pricing of both providers and insurance

• 2 years in medical practice would be an advantage.

• Health Economics/Healthcare & Business Administration related studies would be an advantage.