Job Summary
- The Provider Relations Manager is responsible for managing the relationships between the Health Maintenance Organization (HMO) and its network of healthcare providers.
- This includes negotiating contracts, ensuring adherence to service level agreements (SLAs), and addressing provider concerns.
- The Provider Relations Manager will also oversee the onboarding process for new
- providers, ensure providers are educated on HMO policies, and support ongoing collaboration to ensure the delivery of high-quality care to enrollees.
- The role requires strategic oversight of provider engagement, ensuring both the HMO and the providers are aligned on goals and expectations.
Responsibilities
Provider Network Management:
- Manage and oversee the network of healthcare providers, ensuring that they meet HMO standards and expectations.
- Lead the negotiation of contracts with healthcare providers, ensuring competitive and sustainable agreements.
- Continuously assess provider performance, addressing any issues with service delivery, billing, or quality of care.
Provider Onboarding & Education:
- Coordinate the onboarding process for new healthcare providers into the HMO network.
- Educate providers on HMO policies, procedures, billing processes, and regulatory requirements.
- Develop training programs to ensure providers understand their roles and the expectations of working with the HMO.
Issue Resolution & Support:
- Act as the primary point of contact for healthcare providers, addressing any concerns or issues they may have.
- Resolve disputes between providers and the HMO efficiently and effectively.
- Monitor provider satisfaction and implement improvements based on feedback.
Strategic Provider Development:
- Develop and implement strategies to strengthen and expand the provider network.
- Identify opportunities for collaboration with providers to improve care delivery and reduce costs.
- Work closely with the business development team to expand provider offerings in new regions or service areas.
Data Protection & Confidentiality:
- Uphold the highest standards of confidentiality in handling company-related information, ensuring compliance with data protection laws and internal policies.
- Adhere to the company’s information security guidelines, including proper storage, transmission, and disposal of sensitive materials.
- Promptly report any suspected data breaches or unauthorized access to the appropriate company authority.
- Participate in periodic data protection training to stay informed about evolving security risks and best practices.
General Assignment:
- Execute any other duties and tasks that may be designated or assigned by the Company.
- Participate in the knowledge sharing programme of the department and the company.
- To provide supports to the Managing Director and Vice Chairman as may be required towards serving the Board, Management and staff.
KPIs and Performance Metrics
- Provider Engagement: Positive feedback from healthcare providers regarding communication and support.
- Network Expansion: Growth in the number of providers in the HMO network.
- Contract Negotiation Success: Percentage of successfully negotiated provider contracts.
- Provider Satisfaction: Improvement in provider satisfaction scores from surveys.
- Service Level Agreement (SLA) Compliance: Percentage of providers meeting HMO SLAs for care delivery.
Qualifications
Education:
- Bachelor’s Degree in Healthcare Management, Business Administration, or related field.
Experience:
- Minimum of 5 years of experience in provider relations or network management, with at least 2 years in a supervisory role.
Skills and Competencies:
- Strong negotiation skills and the ability to manage multiple provider contracts.
- Excellent interpersonal and communication skills for building relationships with providers.
- Knowledge of healthcare regulations and HMO policies.
- Analytical skills to assess provider performance and make data-driven decisions.