Provider Liaison Administrator

Job Description

  • Profiles the Service Providers for enrolment onto the service provider network using analysed data and knowledge of Providers
  • Plans and organises engagement meetings with Service Providers to build relationships with them
  • Creates Cimas outposts with existing doctors and robust referral system within the Blue Zone network
  • Determines financial incentives and utilizes data and feedback to identify opportunities to improve the relationship between Cimas and Service Providers
  • Gathers medical industry information, interprets, and shares with internal contact for the benefit of the organization
  • Refers to the Provider Liaison Coordinator, Head Managed Care and Forensic Department identified cases of suspected fraud, waste, abuse and follows up the cases to finality
  • Supervises calculation and compilation of tariff schedules in line with medical aid tariff reviews and forwards to the Head Managed Care for quality control
  • Conducts research on alternative reimbursement models for medical aid cost containment and recommends to the Head Managed Care
  • Participates in Cimas weekly tariff committee meetings where discussions on innovative ways of handling tariffs to provide value are discussed
  • Monitors registration of service providers onto the Cimas System
  • Designs and reviews training materials for provider training workshops
  • Reviews provider claims to ensure compliance to claiming procedures
  • Arranges the accreditation of new institutions in line with Cimas standard operating procedures

Candidate Requirements

  • Diploma/Degree in General Nursing or any relevant Health Degree
  • Desirably a Post- Graduate qualification in Health Sciences
  • Valid Practicing Certificate as a Registered Health Practitioner
  • Experience in Healthcare Digital Systems Administration, Claims Handling and Knowledge of Healthcare Finance
  • Ability to manage and develop staff
  • Clear verbal and written communication and ability to prepare accurate reports
  • Ability to plan and organise in line with job requirements
  •  Ability to interact, negotiate and achieve targets

Applications Closed

The position is closed from applications.