Provider Relations Manager

Job Summary

• The Provider Relations Manager is responsible for managing the relationships between the Health Maintenance Organization (HMO) and its network of healthcare providers.
• The Provider Relations Manager will also oversee the onboarding process for new
• The role requires strategic oversight of provider engagement, ensuring both the HMO and the providers are aligned on goals and expectations.
• This includes negotiating contracts, ensuring adherence to service level agreements (SLAs), and addressing provider concerns.
• providers, ensure providers are educated on HMO policies, and support ongoing collaboration to ensure the delivery of high-quality care to enrollees.

Responsibilities
Provider Network Management:

• Manage and oversee the network of healthcare providers, ensuring that they meet HMO standards and expectations.
• Continuously assess provider performance, addressing any issues with service delivery, billing, or quality of care.
• Lead the negotiation of contracts with healthcare providers, ensuring competitive and sustainable agreements.

Provider Onboarding & Education:

• Educate providers on HMO policies, procedures, billing processes, and regulatory requirements.
• Coordinate the onboarding process for new healthcare providers into the HMO network.
• Develop training programs to ensure providers understand their roles and the expectations of working with the HMO.

Issue Resolution & Support:

• Resolve disputes between providers and the HMO efficiently and effectively.
• Act as the primary point of contact for healthcare providers, addressing any concerns or issues they may have.
• Monitor provider satisfaction and implement improvements based on feedback.

Strategic Provider Development:

• Identify opportunities for collaboration with providers to improve care delivery and reduce costs.
• Work closely with the business development team to expand provider offerings in new regions or service areas.
• Develop and implement strategies to strengthen and expand the provider network.

Data Protection & Confidentiality:

• Promptly report any suspected data breaches or unauthorized access to the appropriate company authority.
• Uphold the highest standards of confidentiality in handling company-related information, ensuring compliance with data protection laws and internal policies.
• Participate in periodic data protection training to stay informed about evolving security risks and best practices.
• Adhere to the company’s information security guidelines, including proper storage, transmission, and disposal of sensitive materials.

General Assignment:

• Execute any other duties and tasks that may be designated or assigned by the Company.
• Participate in the knowledge sharing programme of the department and the company.
• To provide supports to the Managing Director and Vice Chairman as may be required towards serving the Board, Management and staff.

KPIs and Performance Metrics

• Contract Negotiation Success: Percentage of successfully negotiated provider contracts.
• Provider Satisfaction: Improvement in provider satisfaction scores from surveys.
• Service Level Agreement (SLA) Compliance: Percentage of providers meeting HMO SLAs for care delivery.
• Network Expansion: Growth in the number of providers in the HMO network.
• Provider Engagement: Positive feedback from healthcare providers regarding communication and support.

Qualifications
Education:

• Bachelor’s Degree in Healthcare Management, Business Administration, or related field.

Experience:

• Minimum of 5 years of experience in provider relations or network management, with at least 2 years in a supervisory role.

Skills and Competencies:

• Strong negotiation skills and the ability to manage multiple provider contracts.
• Excellent interpersonal and communication skills for building relationships with providers.
• Knowledge of healthcare regulations and HMO policies.
• Analytical skills to assess provider performance and make data-driven decisions.