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
Reports to: The MD/CEO
- To ensure robust provider relationship management, optimal satisfaction of all clients through excellent service delivery and ensure all stakeholders receive great customer service
- 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.
- 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.
- 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
- Experience working in a multicultural environment with diverse patient population would be an advantage
- Excellent client-facing and internal communication skills
- 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
- Relationship Management
Application Closing Date
5th April, 2019.
How to Apply
Interested and qualified candidates should kindly send their updated CV to: firstname.lastname@example.org 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.
- 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.