FIND YOUR BETTER AT Blue Care
If you believe in better, we'd love to hear from you.
About the Role
Responsible to assist in establishing the strategy, creation, direction and evolution of the provider network. The incumbent will liaise with providers and conduct ongoing evaluation of network performance so as to ensure a complete, stable, accessible well-regarded and high-quality delivery system.Responsibilities:
Setup and maintain provider network
Initiate and maintain network provider for health services.
Administer credentialing process and operation of network provider.
Establish working procedure and identify control process for compliance to service standards.
Accomplish the requirement for panel network to perform eligibility check and EDI claims submission for accuracy and efficiency.
Conduct briefing/training to internal staff.
Attend panel meeting / facility visits for ensuring accuracy in panel system setup and administration.
Setup and maintain network provider data in system for eligibility check, provider information display, prior authorization and claims processing.
Review system performance and identify areas for technical support team to monitor for stability.
Execute manual support for maintaining customer satisfaction during system stoppage or slow response due to technical issue.
Review network provider quality
Review on network provider to identify areas for improvement.
Provide recommendations to network providers after investigation of reported servicing issue.
Monitor network providers performance within the established service standard.
Conduct regular meetings with Panel Network for utilization review and service excellence.
Identify problems which affect the Network and proactively communicate with management.
Maintenance on business services
Coordinates with different teams to maintain the service standard to our clients.
Assist on the business renewal and support on RFP/ tender requirement
Assist on individual product design requirement
Manages the service arrangement for health talks, check-up or onsite biometric assessment to clients
Other duties and responsibilities
Assist to coordinate health care related services for enhancing customer satisfaction.
Participate in projects relating to service enhancement or new business initiatives arise.
You are required to obtain relevant license if your job involves in regulated activities
Other duties and responsibilities as assigned by supervisor.
Requirements:
University Degree in Business Studies, Health Administration or relevant disciplines.
Minimum 6-8 years relevant experience with at least 5 years in healthcare industry.
Registered nurse is preferred.
Customer service and presentation experience required.
Strong business communication, analytical, problem solving, documentation and organizational skills.
Knowledge of Healthcare billing and medical terminology.
Strong business analytical, documentation and organizational skills.
Proficient in both spoken and written Chinese and English.
Strong communication and negotiation skills.
Others:
You are required to obtain the relevant license(s) if your job involves regulated activities
