إرفاق
وصف الوظيفة
To accomplish contract administration, pricing & coding, extracting data and network system maintenance through the implementation of the agreed department action plans and rules to achieve system efficiencies within the agreed timescales.
Contract Administration:
- Implement the set contracts’ uniformity,standards and regulatory compliance with all providers.
- Coordinate the logestics of contracting new providers ,new service codes and the renewal of contracts .
- Ensure that all providers’ files and system data are completed and updated in consistency with all agreements and amendments filing of contracts.
- Update systems and follow up the expiration dates of the contracts within the agreed timescales.
- Review providers’ coding and remove redundant and duplicate codes of the providers
- Monitor, regularly, the expiration of regulatory licensing of the providers to achieve timely renewals.
Benchmarking:
- Extract data necessary for benchmarking of services.
- Maintain updated master sheets for the benchmarks.
- Conduct price comparisons with the benchmarks whenever needed.
Pricing, Discounts and Codings:
- Identify redundant and duplicate code to help the revamp of the coding system.
- Collect, regularly, statements’ data of invalid service codes and billing above agreed prices for resolution
- Coordinate, internally and externally, for the resolution of coding and pricing default
- Upload the new prices, contracts and amendments in the operating systems.
- Review the first 3 statements of providers with new price amendmends to ensure providers’ compliance.
- Report, regularly, system and statement errors to the line manager.
Network Design and Management:
- Ensure that network changes are updated in the systems
- Monitor providers, physicians and service finder for website support and development.
- Maintain updated master sheet for providers network distribution
Volume Allocation:
- Extract referral data and reports to monitor the implementation of referral rules.
Coordination and Communications:
- Coordinate with the operating team and technical stakeholders to ensure the implementation of addition /deletion of contracts/providers, amendments and significant contract milestone
المهارات
· 1-2 years in healthcare insurance business, data analysis and coding systems.
· Graduate of Paramedical or Allied Health Sciences (Preferrable)
· Coding systems
· Healthcare insurance business
· Computer skills
· Data analysis
تفاصيل الوظيفة
المرشح المفضل
Bupa Arabia
Bupa Arabia is a healthcare insurance company based in the Kingdom of Saudi Arabia. We are an associate business of Bupa Group, which is a global healthcare company with an international reach that extends across multiple business operations, practices, and resources.
Founded in October 1997, Bupa Arabia was initially established through a partnership between Bupa Global International and Nazer Group, with the key focus to provide health insurance services with high quality and competitive prices, while ensuring a distinctive experience for customers. Bupa Arabia has since evolved into a fully Saudi-owned and operated company. Our transformation from a joint venture into a publicly traded company on the Saudi Stock Exchange occurred in 2008, as we made 40% of our shares available to the public during our Initial Public Offering (IPO).
As a subsidiary of the global Bupa Group, we draw upon international expertise while maintaining a profound understanding of local healthcare requirements and regulations. This allows us to offer comprehensive healthcare insurance solutions tailored to the unique needs of the Saudi Arabian market.
Bupa Arabia prides itself on its commitment to the wellbeing and development of its employees, providing them with the same standard of care, support, and professionalism that it expects to be delivered to its customers.
Our core values shape every aspect of our work and culture:
Commit – Own it with accountability and urgency.
Collaborate – Win together through cross-functional synergy.
Care – Put people first, both employees and customers.
