We are looking for a Provider Network Liaison Specialist.
The Provider Network Liaison Specialist serves as the key link between Universal, its contracted network providers, and client medical schemes. The role is responsible for building, maintaining, and strengthening relationships with healthcare providers and key client stakeholders to ensure network compliance, operational efficiency, and the sustainability of the schemes under administration.
The Liaison Specialist will also be responsible for the analysis and monitoring of provider utilisation patterns to identify trends, inefficiencies and opportunities for behavioural change and cost optimisation.. In addition to the above, the Liaison Specialist will support the development and expansion of existing and new networks as determined by Universal Care and the Scheme.
Duties and Responsibilities
The following are the tasks required of the Provider Network Liaison Specialist:
- Develop and maintain strong, collaborative relationships with Network providers (all Network disciplines) and hospitals through regular practice visits in line with the schedule approved by the Provider Networks Senior Manager.
- Identify and address non-compliance by analysing provider claiming patterns and profiles, and by engaging directly with providers to resolve identified issues.
- Build and expand on current and new networks as determined by Universal Care and our clients.
- Analysis and monitoring of provider utilisation data to identify trends and implement corrective or improvement initiatives that promote appropriate and cost-effective care.
- Provide accurate information and guidance to Network Providers on matters related to network benefits, policies and operational processes.
- Promote Universal Care’s image and reputation through professional, solution-oriented engagements with Network Providers and their staff.
- Monitor the quality of care and service provided to members by the Network providers and address any areas of concern.
- Respond promptly and accurately to queries from providers, clients, both internal and external, via email, telephone or in person.
- Identify recurring issues and/or potential trends affecting Network providers and recommend effective interventions and process improvements.
- Ensure accurate documentation of all interactions, visits and actions taken, maintaining comprehensive records for audit and reporting purposes.
- Submit accurate daily productivity and activity reports to the Provider Networks Senior Manager.
- Investigate cases of high utilisation to determine underlying causes and recommend provider-specific interventions to reduce unnecessary costs.
Required profile for job ad : Provider Network Liaison Specialist - Namibia
Staff functions
The Provider Network Liaison Specialist has a staff function relationship with the following positions:
- Customer Service staff
- Medicine Management
- Claims assessing staff
- Provider Network staff
- Membership
- Finance
- Fund Management
Objective of the position
The objectives of the Provider Liaison Specialist are, but not limited to:
- Strengthen Provider Relationships
- Ensure Network Compliance
- Improve Quality of Care and Service Delivery
- Support Provider Education and Communication
- Support Scheme Sustainability
- Enhance Universal Care’s Brand Reputation
- Facilitate Effective Stakeholder Engagement
Experience and Qualifications
- Matric
- 5-10 years’ experience within the Provider Network Management environment.
- Experience in visiting and consulting with healthcare providers on behalf of the employer is essential.
- Experience in relationship management is essential
- Relevant healthcare industry experience
- Experience in a medical scheme environment and claims processing an advantage
- Experience and knowledge of basic pathology and radiology an advantage
- Experience and knowledge of the medical scheme’s legislation particularly an advantage
Required Skills
- Strong relationship management and communication skills
- Ability to work independently and collaboratively across multidisciplinary teams
- Attention to detail
- Customer service focus
- Conflict resolution skills
- Ability to solve problems in a customer friendly manner
- Analytical ability to interpret utilisation and compliance data
- Be effective, efficient and outcomes driven.
Language requirements
- English: Primary business language. Be able to speak, write, spell, read and comprehend the language.
- All written and verbal communication must be conducted in a professional manner.
- Strong verbal and written communications skills.
Computer literacy
- Proficiency with the following programmes is required:
- MS Word
- MS Excel
- MS Outlook/ email
- MS Explorer/Internet
Some prior knowledge/experience with medical scheme administration systems, understanding of medical aid claims and/or managed care system.
Work Requirements
- Hours of work: Office hours from Mon to Fri, 8am to 5pm. Travel hours will be determined by the Provider Network Manager.
- Willingness to work longer hours when the business needs require the Network Liaison Specialist to do so.
- Confidentiality of all patients’ clinical information and conditions to be maintained and respected. The employee may be required to sign a confidentiality agreement.
- Company intellectual property and systems may not be disclosed to external agent or organization.
- Position will be based in Namibia
Remuneration
- A competitive salary and benefits will be negotiated, consistent with experience and the role and responsibilities of the position
- The Employment Equity approach of Universal Healthcare broadly aims to:
- Foster diversity in the workplace;
- Promote equal opportunity and fair treatment in employment through the elimination of all forms of unfair discrimination.
