Senior Executive Manager - PR Contracts Management.

Contract Mangement:

·    Set up the  contracts’ rules and standards with all providers for the best interest of the busines

·   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.

·   New Providers facility field visit, evaluation & scoring.

 Pricing , Benchmarking, Discounts and Coding:

·    Revamp the coding system and ensure cleaning up redundancy and duplication.

·    Ensure the resolution of defaults of the invalid & duplicate service codes and overbilling.

·    Develop standard discount structure, PPD rules and slabs of volume discount

·    Introduce systems for comprehensive benchmarks for frequently billed items (regional and per network)

·    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 members or other business units.

·   Develop pricing models, guidelines & benchmarks for optical and other unique services.

 Cost Effectiveness:

·     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.

·   Provide business stakeholders with price forecasting on regular basis and whenever necessary

 Network Design and Volume Allocation Management:

·    Ensure that the network of providers is comperhensive and covering all benefits for each class.

·    Enhance , regularly ,the providers network (down/up grading) based on risk cost and business requirements

·    Optimize accessible and affordable network .

·    Practice type network management.

·    Enhance  stepladder referrals system with regular updates to achieve best practice and cost effectiveness.

·    Develop network of anchor providers and centers of excellence

·    Manage volume re-allocation of all or specific services from one provider to another whenever indicated

 Coordination and Communications:

·     Ensure that  addition/deletion of  contracts/providers ,amendments and significant contract milestone are communicated to the operation team and technical stalkeholders.

·     Communicate regular price forecast to the commercial finance

·     Communicate network redesign ,referral system updates to operation team and sales.

·     Coordinate with sales ,marketing and commercial finance volume re allocation ,healthcare plans  and network updates

People Management:

·     Provide leadership ,professional guidance and directions to the assigned  team members.

·     Preparing and overseeing KPI for the team.

·     Ensure and facilitate goal setting ;manage and constantly review individual performance

·     Provide regular feedback ,coaching ,and development

·    Motivate ,empower and enable direct reports by providing technical expertise , necessry tools and support required to achieve the organizational development objectives

·    Build the capabilities of the team members.

·       8+ Years

·       Analytical mindset & Presentation skills

·       Hospital management (preferrable)

·      Contracts & Prices negotiations.

·       Familiarity with healthcare pricing and emerging models of care in the market.

·      Bachelor of Medicine and surgery

·      Good knowledge of health insurance market regulations.

·      2 years in hospital management (preferrable)

·      2 years in healthcare insurance business

·      2 years experience in contracting and pricing of both providers and insurance

·      2 years in medical practice would be an advantage.

·     Health Economics/Healthcare & Business Administration related studies would be an advantage.