Provider Network Supervisor
Maxicare Healthcare Corporation
Date: 2 days ago
City: Makati City
Contract type: Full time
- 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.
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