Responsible for all aspects of participation in contracting with the assigned providers
Implement strategies to accurately determine the cost of the provider to Daman
Ensure that all negotiations are in line with Daman’s pricing targets, optimum services and payment terms
Carry out procedure code mapping for the contracted services with the healthcare providers as needed
Review provider dashboards and quality reports to measure provider performance and utilisation
Prepare weekly action plan in managing assigned providers and provide update / status reports to the superior
Ensure that the agreed terms are properly implemented and documented
Schedule and perform provider site visits according to specific needs
Provide education and training on Daman Provider Manual, Provider Guide, Quality measures, and performance standards to all providers assigned
Handle any issues that may arise from the providers and ensure that these are addressed and resolved in a timely manner
Act as a resource in the department to handle any clinical related issues including but not limited to membership on clinical committees, evaluation of issues that require clinical specialised knowledge in specific clinical areas
Act as point of contact in areas requiring professional advice on specific medical processes
Attend clinical conferences, workshops or classes to ensure that knowledge base is current
Promote knowledge sharing by providing training and sharing new information with colleagues, relevant in properly carrying out the department’s function
Participate in special projects as may be assigned
Skills
Good command of written and spoken English; knowledge of Arabic language is an advantage
Good analytical, execution, problem solving and decision making skills
Ability to acquire and apply new skills
Flexible and able to work under pressure
Flexibility to travel within the UAE
Respect and maintain a high level confidentiality
Proactive and results oriented whilst ensuring high quality of work
Advance level of customer service orientation and professionalism in all interactions
Able to work in a multi-cultural environment and promote teamwork and knowledge sharing in order to achieve goals and deliverables
Good knowledge of health insurance concepts
Good knowledge of Microsoft applications
Knowledge of claims cost and coding structure to steer the quality of coding is a plus
Up-to-date medical knowledge is preferred
Knowledge of contracting with health care providers, claims or billing is preferred
Technical knowledge with respect to relevant regulation and procedures
