Provider Planning, Monitoring and Access Coordinator Job in a Health Maintenance Organization
Hamilton Lloyd and Associates - Our client is a Health Maintenance Organization. Due to internal expansion, they are looking to fill in the role below:
Job Title: Provider Planning, Monitoring and Access Coordinator
Location: Lagos
Reports to: The MD/CEO
Job Summary
- To ensure robust provider relationship management, optimal satisfaction of all clients through excellent service delivery and ensure all stakeholders receive great customer service
Main Responsibilities
- Develop and execute strategic plan to acquire and manage HMO providers across the regions.
- Provide thorough assessment and credentialing of provider facilities.
- Ensure prompt attention and resolution to provider issues.
- Documentation of all formal provider complaints and issues with resolution plan and implementation dates.
- Drive required expansion of provider network within the regions.
- Organize and conduct provider forum annually
- Maintain an updated provider directory.
- Identify providers for member specific health needs.
- Ensure prompt investigation/resolution of complaints against providers from clients
- Conduct frequent and timely provider education for the providers on the health plans
- Ensure effective case management/referral of enrollees on admission.
- Verify and give approvals to enrollee requests from providers.
- Maintain records of all approvals given to providers with the relevant details.
- Conduct timely provider's activities as stated in the cycle (payment reconciliation, utilization reviews and hospital reassessments).
- Retrieval, update and record-keeping of all provider credentials and correspondence.
- Conduct tariff negotiations for provider services.
- Monitor provider network to ensure quality assurance.
- Ensure providers have sufficient supply of NHA documentation material (encounter, referral forms etc).
- Resolve all problems related to medical claims eligibility or benefits
- Resolve issues before claims payment to avoid re-adjunction
- Maintain high level of professionalism and competence in every enrollee/provider interaction.
- Build positive and productive relationships with enrollees.
- Make frequent client calls and visits to strengthen enrollee relationships.
- Analyze and resolve service issues promptly.
- Inform management about complex enrollee issues and resolutions.
- Develop process improvements to enhance service efficiency and effectiveness.
- Provide support in new product development and enhancement activities.
- Develop open and effective channels of communication with each enrollee that can be employed by other departments as well
- Work directly with enrollees to effectively manage their needs and preferences
- Develop and foster growth within existing clientele
- Frequently check-in with clients to confirm their satisfaction of services provided
- Exhibit expert knowledge regarding the products and services offered
- Work according to set standards and operating procedures
- Ensure effective and prompt enrolment of members
- Ensure quality assurance of HMO services to enrollees
- Follow up on approvals to enrollee requests from clients
- Ensure proper onboarding and induction of new members
- Build and maintain relationships with clients and key personnel within client’s companies
- Assist to organize physical health forum and enlightenment program chart and timetable for enrollees.
- Provide accurate and timely information on benefits and services available to members.
- Ensure completion of client management cycle effectively.
- Conduct business reviews to ensure enrollees are satisfied with the service rendered
- Monitor company performance against service level agreement and flag potential issues
- Liaise with internal departments to ensure enrollee needs are fulfilled effectively
- Carry out post-induction survey, client satisfaction survey and reviews
- Coordinate client-focused internal projects and determine the best utilization of resources to increase customer satisfaction
- Assist to develop, plan and execute of effective call center operations for NHA
- Ensure that calls and emails are answered within agreed time scales and in line with the company’s SOP.
- Recommend process improvements.
- Meet performance targets for speed, efficiency and quality;
- Ensuring all relevant communications, records and data are updated and recorded;
- Maintaining up-to-date knowledge of industry
- Ensuring that a high level of customer service and support is provided to all internal and external customers
- Perform any other duty as required by management.
Minimum Education
- Bachelor of Medicine, Bachelor of Surgery Degree (MBBS, MBChB, BMBCh or MD)
- Fellowship/membership must be registered with the Medical and Dental Council of Nigeria (MDCN)
- Current Full Registration with a National Medical Licensing body e.g. Nigerian Medical & Dental Council (MDCN); General Medical Council (GMC), etc.
Experience:
- Minimum of 10 years' experience post NYSC
- Minimum of 5 years cognate experience in relevant and related field
Key Skills and Competencies:
- Good Leadership and Management experience
- Excellent written and verbal communication skill
- Superior patient/customer service, ethics, and manners
- Excellent critical thinking, deductive reasoning and decision making skills.
- Good computer skills
- Experience working in a multicultural environment with diverse patient population would be an advantage
- Excellent client-facing and internal communication skills
- Relationship Management
How to Apply
Interested and qualified candidates should kindly send their updated CV to:
[email protected] with the title of the role as the subject of the mail. The body of the mail should outline Total years of relevant experience to the role, Location and Age.
Note
- Please read Role necessities very carefully and apply if qualified. Only qualified candidates will be contacted.
- If after 2 weeks of application you do not hear from us, kindly consider your application as unsuccessful.
Application Deadline: 5th April, 2019.