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.

Qualification

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 managerial 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.

KPIs and Performance Metrics

1. Provider Engagement: Positive feedback from healthcare providers regarding communication and support.
2. Network Expansion: Growth in the number of providers in the HMO network.
3. Contract Negotiation Success: Percentage of successfully negotiated provider contracts.
4. Provider Satisfaction: Improvement in provider satisfaction scores from surveys.
5. Service Level Agreement (SLA) Compliance: Percentage of providers meeting HMO SLAs for care delivery.