Role Purpose:
To manage the commercial and contractual relationship with Bupa network providers to ensure compliance with regulators to deliver business benefits.
Key Accountabilities:
1- Reconciliation of the accounts;Analyze and monitor the cost effectiveness of the unit and utilization of provider services for better control.
Plan reconciliation meetings including scheduled meetings, coordination with medical manager, preparation of financial figures and negotiation.
Negotiate the reconciliation with the providers to achieve the set targets.
Document the reconciliation points and send feedback to the claims department and regional manager.
Support in the preparation of presentations to the owners of top 20 providers to highlight trends and errors.
Ensure that the reconciliation is conducted on a regular basis and in line with CCHI regulations.
2- Contract management;Maintain existing and renewed contracts to identify and resolve issues to enhance commercial terms and improve operations.
Establish good relationships with new providers and assess the integration for Bupa network by comparing their prices in network hospitals, considering the providers' location and the geographic distribution of the members.
3- Improved commercial terms;Enhance the commercial trading terms by negotiating and signing up improved prices and discounts to guarantee that Bupa will achieve the price reduction targets set annually.
Prepare the proposals for improved prices and discount structures of the frequent services and packages in coordination with the commercial team and medical managers.
Negotiate and agree with the providers on the improved prices to help score better deals for the identified high-value claims on a real-time basis.
Communicate the agreements to the commercial and support team for uploading and implementation.
Monitor the compliance of the providers with the agreements on their claims statements.
4- Communications and trends resolution;Plan and carry out regular visits to the providers in order to maintain professional relationships.
Support in following up on issues raised during negotiation with providers.
Identify the critical trends in medical practice of service providers.
Manage the delivery of training sessions and development programs of providers' staff on new Bupa systems, policies, and procedures.
Maintain relations with other medical teams in the business including the hospital claims integrity team.#
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