Job Description

  • 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 physician’s affiliation and changes on CPT rates of assigned Providers.


Job Details

Role Level: Not Applicable Work Type: Full-Time
Country: Philippines City: Makati National Capital Region
Company Website: https://www.maxicare.com.ph Job Function: Healthcare Administration
Company Industry/
Sector:
Hospitals and Health Care

What We Offer


About the Company

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