Job Summary
We are seeking a Provider Network Manager who will be responsible for overseeing the development and management of the healthcare provider network within the organization. This role involves identifying and sourcing third-party providers in the healthcare, fire, security and ancillary services and conducting regular audits, ensuring compliance with regulatory requirements, and fostering positive relationships with providers to enhance the quality and efficiency of healthcare services for insured members. To be successful in this role, you should have a strong background in auditing principles, meticulous attention to detail, and demonstrate excellent communication and management skills to ensure service quality and build healthy relationships.
- Minimum Qualification: Degree
- Experience Level: Senior level
- Experience Length: 6 years
Job Description/Requirements
Responsibilities:
- Identify and source third-party providers in the healthcare, fire, security and ancillary services
- Evaluate provider networks to ensure an adequate selection of healthcare professionals and facilities to meet the needs of insured members.
- Conduct market analysis and research to identify areas for network expansion or improvement
- Negotiate provider contracts, fee schedules, and reimbursement rates to ensure competitive pricing and favourable terms for the organization.
- Collaborate with legal and compliance teams to review and finalize contracts, ensuring adherence to regulatory requirements and company policies.
- Build and maintain positive relationships with healthcare providers to foster collaboration and cooperation.
- Address provider inquiries, concerns, and disputes in a timely and professional manner, striving to resolve issues and maintain provider satisfaction.
- Collaborate with providers to implement quality improvement initiatives and enhance the delivery of healthcare services.
- Monitor and ensure compliance with regulatory requirements, accreditation standards, and contractual obligations related to provider networks.
- Stay abreast of changes in healthcare laws, regulations, and industry trends affecting provider contracting and reimbursement.
- Analyze provider performance metrics, utilization patterns, and financial data to assess network effectiveness and identify areas for improvement.
- Prepare and present reports on network performance, contract negotiations, and provider utilization to internal stakeholders.
Qualifications and Professional Experience
- Bachelor's degree in Accounting, Finance, or related field, Master's degree preferred.
- 6 years of experience in healthcare provider network management, as an auditor, or related field.
- Strong understanding of healthcare reimbursement methodologies, contract negotiation principles, and regulatory requirements.
- Excellent communication, negotiation, and relationship-building skills.
- Knowledge of healthcare industry trends, practices, and emerging technologies.
Key Competencies
- Excellent analytical, problem-solving, and communication skills.Â
- Meticulous attention to detail and accuracy.
- Proficiency in data analysis and reporting tools.
- Ability to work independently, prioritize tasks, and manage multiple projects simultaneously.
- Excellent organisational skills.
- Ability to prioritize tasks and meet deadlines.
Remuneration: NGN 700,000
- HMO
- Pension
- Performance Bonus
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