Reviews and evaluates application of new providers and physicians based on the submitted documentary requirements
Collates data, analyzes and drafts service agreements, presents and discusses with new providers, and with existing providers in cases of renewal or signing of service agreements.
Coordinates and processes the submitted documents and signed service agreements of new and existing providers and physicians
Conducts ocular visit and inspection in the providers facilities.
Conducts orientation to both providers and physicians.
Endorses submitted and signed documents and details for set-up prior announcement to all concerned departments. Ensures that all details are correctly uploaded/updated in the system.
Conducts regular visits to Providers. Provider visit is an avenue to do business review, cascading of new or updated guidelines and policies of the company, discussion of service-related issues and concerns, payment reconciliation issues, systems improvement, and provisions of the service agreement
Negotiates and discusses with new and existing providers packages, discounts, service agreements, and automation initiatives.
Resolves, responds or escalates any concerns raised by providers and physicians in assigned areas through emails or meetings with providers and physicians.
Reviews, analyzes and escalates claims and payment concerns/issues to the concerned unit / department.
Reviews and monitors resolutions and recommendations from concerned departments, and discusses it with the provider/physician
Reviews, analyzes, prepares recommendations on how to manage stale claims and submits to Claims Department
Collates, analyzes and prepares data and submits reports to Immediate Heads on the proposed changes and enhancements on the provisions of the service agreement from providers and physicians.
Collaborates with Marketing and Sales Departments in providing feedback on incident reports raised by internal clients and members.
Reviews and endorses the status of a physicians affiliation and changes on CPT rates of assigned Providers.
