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Network & Medical Coding Manager

Tawuniya Inssurance Verified

Riyadh , Saudi Arabia

Posted Feb 18, 2019 564 views

SAR. 20,000 - 25,000/Month

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Job Description

JOB PURPOSE

'' Build, develop, monitor and consistently upgrade / expand the provider network in line with Tawuniya’s to ensure providers are assigned to the right network and the network performs to standard."

PRINCIPAL ACCOUNTABILITIES:

  • Review and quality assure all services and work-products delivered by the department/unit in accordance with established policies and procedures.
  • Devise and improve operational policies and procedures in line with corporate and strategic guidance.
  • Deploy allocated resources for optimal performance and provide feedback to the direct line manager on resource requirements.
  • Monitor staff achievements, perform periodic performance appraisals, and provide guidance, coaching or training to direct reports in performing their delegated duties.
  • Ensure the performance of duties and conduct of staff is in accordance with the departmental/unit business processes and operating procedures.
  • Continuously monitor performance against targets and objectives, identify areas of improvement to increase efficiency and effectiveness of the team and take action.
  • Manage, evaluate and assess price lists of providers interested in joining Tawuniya's network by: Updating contracts due for renewals or services, making recommendations on price lists by benchmarking price list with network recommended, developing databases, regularly reviewing and updating price lists, implement coding concept (international standard coding) to ensure the price list falls within range and costs are managed effectively/efficiently.
  • Advise pre authorisation team on cost “pain” areas. Interact with contract admin during renewal of contracts phase to advise on “unusual services” costs by discussing options for provision of services that may be provided by another provider cost effectively to ensure efficiency and cost effectiveness.
  • Add providers to recommended networks (based on costs) by expansion or shrinking the network by: Assessing the relationship, price list, discount structure, client needs, criticality of the provider (remote areas) increasing experience of clients and provider (positive) . Visit new providers to make decisions about suitability for networks to ensure high quality relationships.
  • Review network performance on a regular basis (quarterly) to advise Head of PR and Managers about required changes that require changing the provider network position . Meet with provider stressing unusual/gap and assessment result (with the PR Manager). Evaluate the expansion of network if needed. Advise on where provider should be positioned in assigned networks to ensure the providers are within network costs and reduce potential risks.
  • Support contract management by advising contract management on details related to price list and other discount privelages that were agreed and negotiated with the provider by PR Manager, review cases where services are not available as they are not on the price list (e.g partial approval) to ensure price lists containing services and procedures are within benchmark and cost ranges.
  • Ensure strong internal communication on network changes by communicating with all relevant stakeholders on changes made to network to ensure important infiornmation is shared.
  • Support claim management / fraud in detecting any threats or gaps discovered through billing behavior by utilizing meetings and reporting tools to avoid pay or settle any suspected fraudulent claims.
MINIMUM KNOWLEDGE AND EXPERIENCE REQUIRED

LEVEL OF EDUCATION: Bachelor’s degree in any subject.

EXPERIENCE: 8 - 10 Years Overall Years of Experience, 5 Years Experience in managerial position.

CERTIFICATION: Institute of Banking Insurance Foundation Certificate Exam (IFCE).

Job Details

Functional Area:
Total Positions:
1 Post
Job Shift:
First Shift (Day)
Job Type:
Department:
Medical&Takaful
Job Location:
Gender:
No Preference
Minimum Education:
Bachelors
Career Level:
Experienced Professional
Minimum Experience:
7 Years
Work Permit:
Saudi Arabia
Apply Before:
May 18, 2019
Posting Date:
Feb 18, 2019
Show fewer details Read full job description

Tawuniya Inssurance

Insurance / Takaful · 601-1000 employees - Riyadh

The Company for Cooperative Insurance (Tawuniya) was founded in 1986 in Riyadh as a Saudi joint stock company and the first licensed national insurance company in Saudi Arabia offering various insurance products commensurate with the needs of the community of individuals and companies in accordan ...Read More