Senior Manager Network & Contracts Management Provider Relation
Bupa Arabia
Total years of experience :15 years, 4 Months
Contract Administration
Maintain contracts’ uniformity and standards with all providers.
lead and engage in contracting new providers, new service codes and the renewal of contracts.
Maintain contracts’ compliance with the regulatory, renewals and licensing requirements.
Monitor contracting administration to ensure timely processing and finalization.
2
Benchmarking
Identify frequently billed items in each region.
Collect price range for each frequent item per network, in each region.
Collect prices/quotations for other items/services whenever needed (experienced) or requested.
Allocate usual, customary and reasonable prices for new service codes and items outside the benchmark.
Support other business units in pricing services and items.
Implement standard optical and dental pricing models.
Monitor compliance of providers’ agreements and pricing with the benchmarks and related guidelines.
3
Pricing, Discounts and Codings
Plan, engage and follow the revamp of coding systems.
Monitor the resolution of defaults of the invalid & duplicate service codes and overbilling.
Coordinate, internally and externally, for the resolution of coding and pricing defaults.
Engage in business obligations of ICD 10-am implementation.
Ensure that new prices, contracts and amendments are uploaded in the operating systems.
Monitor the implementation of discounts, PPD and volume discounts.
4
Cost Effectiveness
Identify items potential areas for price reductions to achieve business targets with the assigned providers
Identify providers and services’ potential for bundling (in & out patients) and expansion of surgical packages.
Plan, follow and engage in negotiating price reductions and bundling with the assigned providers.
Calculate and analyze the financial impacts of proposal and agreements of new contracts/service codes and renewals.
Maintain up-to-date tracker sheet for the price increases .
contracting with medical providers
detecting any fraud
auditing claims
strategic planning
Policies and Procedures JCI Certification ISO Certification Strategic Planning Six sigma projects
Internal medicine and General surgery