Job Summary

The Provider Relations Executive will assist in managing relationships between healthcare providers and the Health Maintenance Organization (HMO). This role involves supporting the onboarding process, coordinating communication between providers and HMO teams, addressing provider inquiries, and helping resolve issues related to claims, billing, or care delivery. The Provider Relations Executive will work closely with the Provider Relations Manager to ensure that providers are well informed and supported in their interactions with the HMO.

Responsibilities

Provider Communication & Support

• Serve as a point of contact for healthcare providers, answering inquiries and providing necessary support.
• Ensure providers are well-informed of HMO policies, procedures, and updates.
• Address and resolve issues raised by providers related to claims, billing, or service delivery.

Onboarding & Training

• Assist in the onboarding process for new providers, ensuring they are familiar with HMO guidelines.
• Help coordinate and deliver educational materials or training sessions for providers on relevant HMO policies and procedures.

Claims & Billing Assistance

• Provide support to providers in understanding and resolving claims and billing issues.
• Act as a liaison between the provider and claims department to ensure timely resolution of issues.

Performance Monitoring & Reporting

• Monitor provider performance and assist in the gathering of feedback from providers regarding their experience with the HMO.
• Prepare reports on provider performance and satisfaction for management review.

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 Administration, Business, or related field.

Experience

• Minimum of 2 years of experience in provider relations, healthcare administration, or customer service within an HMO environment.

Skills and Competencies

• Strong communication and interpersonal skills.
• Problem-solving abilities to handle provider issues effectively.
• Knowledge of healthcare billing and claims processes.
• Customer service-oriented mindset with a focus on provider satisfaction

KPIs and Performance Metrics

1. Provider Support Efficiency: Timely resolution of provider inquiries and issues.
2. Provider Satisfaction: Positive feedback from providers based on surveys and interactions.
3. Claims Resolution: Percentage of claims and billing issues resolved to providers’ satisfaction.
4. Onboarding Success: Successful completion of onboarding for new providers without delays.
5. Performance Reporting Accuracy: Accuracy and timeliness of provider performance reports.