PR Contracting Management

Role Purpose:

To accomplish effective contract management and network design of the providers through the implementation of the agreed providers’ strategy and framework while complying with CHI & SAMA rules & regulations to deliver effective price & cost management and projects’ savings. In addition, aligning with sales & marketing to continuously developing new products & services that support business development & proposition in the insurance market and achieve business profitability and expansion goals.

Key Accountabilities:

1- Contract Management & Cost Effectiveness

• Set up for the assigned portfolio of providers contracts’ rules and standards for the best interest of the business.
• Supervise contracting (and engage whenever necessary) new providers, new service codes and the renewal of contracts.
• Ensuring contracts’ compliance with the regulatory, renewals and licensing requirements.
• Develop (and negotiate whenever necessary) price reduction plans to achieve business goals.
• Develop and enhance plans to agree with the providers on services’ bundling (in & outpatients) and expansion of surgical packages.
• Ensure (and negotiate whenever necessary) that the prices of new & renewed contracts and addition of new services are consistent with the benchmarks and achieving the business targets.
• Prepare, provide & present to business stakeholders negotiation progress status summaries on regular basis and whenever necessary.
• Negotiate with service providers to determine competitive pricing for uncovered services as well, ensuring cost-effectiveness and value for the business, collaborate with internal stakeholders and project teams, ensuring smooth project implementation through the coordination of related contracting activities.

2- Benchmarking, pricing, and Coding

• Develop process, reference and guidelines for items that are not benchmarked to ensure that any item can be reasonably and fairly priced whenever requested by provider, members or other business units.
• Ensure the resolution of defaults of the invalid & duplicate service codes and overbilling.
• Develop standard discount structure, PPD rules and slabs of volume discount.

3- Network Design and Management

• Ensure that the network of providers is comprehensive and covering all benefits for each class.
• Support the regular review for the providers network (down/up grading) based on risk cost and business requirements.
• Provide all required data & inputs to develop a stepladder referrals system with regular updates to achieve best practice and cost effectiveness.
• Develop network of anchor providers and centers of excellence
• Propose ideas for volume re-allocation of all or specific services from one provider to another whenever indicated based on cost efficiency.

4- Service Innovation

• Introduce, develop & support implementation of innovative projects to enhance contracting & network management.
• Explore and develop new payment approaches to cope with business growth.
• Explore, develop & enable potential partnerships with mid-tier providers to enhance and allow market competition.
• Explore introducing new healthcare plans & products that respond to market needs, health & benefits, and business developments.

• Familiarity with healthcare pricing and emerging models of care in the market.
• Analytical mindset & Presentation skills.
• Hospital management (preferrable)
• Contracts & Prices negotiations.
• Good knowledge of health insurance market regulations.

MBBS (Bachelor of Medicine & Surgery)