Provider Contract Support
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Key skills for this role
About the Role
Bupa is seeking a Provider Contract Support to handle contract administration, pricing, coding, and network system maintenance in the healthcare insurance sector. The role requires 1-2 years of experience in healthcare insurance business, data analysis, and coding systems.
Key Skills for This Role
Responsibilities
- Implement contract uniformity, standards and regulatory compliance with all providers
- Coordinate logistics of contracting new providers, new service codes and renewal of contracts
- Ensure providers' files and system data are completed and updated
- Update systems and follow up expiration dates of contracts
- Review providers' coding and remove redundant and duplicate codes
- Monitor expiration of regulatory licensing of providers
- Extract data necessary for benchmarking of services
- Maintain updated master sheets for benchmarks
- Conduct price comparisons with benchmarks
- Identify redundant and duplicate codes for revamp of coding system
- Collect statements' data of invalid service codes and billing above agreed prices for resolution
- Coordinate internally and externally for resolution of coding and pricing default
Requirements
- 1 2 years in healthcare insurance business, data analysis and coding systems
- Graduate of Paramedical or Allied Health Sciences (Preferrable)
- Coding systems knowledge
- Healthcare insurance business knowledge
- Computer skills
- Data analysis skills
Full Job Posting
Job Description
- To accomplish contract administration, pricing & coding, extracting data and network system maintenance through the implementation of the agreed department action plans and rules to achieve system efficiencies within the agreed timescales.
Contract Administration
- Implement the set contracts’ uniformity, standards and regulatory compliance with all providers.
- Coordinate the logistics of contracting new providers, new service codes and the renewal of contracts.
- Ensure that all providers’ files and system data are completed and updated in consistency with all agreements and amendments filing of contracts.
- Update systems and follow up the expiration dates of the contracts within the agreed timescales.
- Review providers’ coding and remove redundant and duplicate codes of the providers.
- Monitor, regularly, the expiration of regulatory licensing of the providers to achieve timely renewals.
Benchmarking
- Extract data necessary for benchmarking of services.
- Maintain updated master sheets for the benchmarks.
- Conduct price comparisons with the benchmarks whenever needed.
Pricing, Discounts and Codings
- Identify redundant and duplicate code to help the revamp of the coding system.
- Collect, regularly, statements’ data of invalid service codes and billing above agreed prices for resolution.
- Coordinate, internally and externally, for the resolution of coding and pricing default.
- Upload the new prices, contracts and amendments in the operating systems.
- Review the first 3 statements of providers with new price amendments to ensure providers’ compliance.
- Report, regularly, system and statement errors to the line manager.
Network Design and Management
- Ensure that network changes are updated in the systems.
- Monitor providers, physicians and service finder for website support and development.
- Maintain updated master sheet for providers network distribution.
Volume Allocation
- Extract referral data and reports to monitor the implementation of referral rules.
Coordination and Communications
- Coordinate with the operating team and technical stakeholders to ensure the implementation of addition/deletion of contracts/providers, amendments and significant contract milestone.
Skills
- 1 2 years in healthcare insurance business, data analysis and coding systems.
- Graduate of Paramedical or Allied Health Sciences (Preferrable)
- Coding systems
- Healthcare insurance business
- Computer skills
- Data analysis
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