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Network Relations Assistant

3.00 to 8.00 Years   Doha, Qatar   04 May, 2023
AL KOOT INSURANCE & REINSURANCE CO.
1 Jobs Openings
Job LocationDoha, Qatar
EducationNot Mentioned
SalaryNot Mentioned
IndustryInsurance & TPA
Functional AreaNot Mentioned

Job Description

Purpose: Network Relations Representative coordinates all aspects of provider network management. Serving as the face of Al Koot to our providers, you will negotiate contracts (rates & terms), drive in-network utilization by ensuring adequate provider depth (coverage area) and breadth (line of business), and ensure high levels of provider satisfaction by treating Al Koot network providers (our key asset) as a client.KEY ACCOUNTABILITIES:Network Management Monitoring Hospital payments with regard to,

  • Bills pending from hospitals for more than _ no of days from date of discharge
If the cashless is availed then the hospital is asked to submit the bills in 7days
  • Shortfalls Payment
  • Addendum: Short payments
Monitoring Authorization related issuesMonitoring the reconsider & Rejected claimRegular visiting to network hospitals and relationship management.Others:
  • Reconciliation of Top 20 potential hospitals across the region
  • Follow up with other departments & Branches on Hospital payments and settlements.
  • Payment within stipulated time
Ensure the MOUs are signed off by the hospitals who are in our network.Team Management
  • Periodic review and evaluation
  • Motivation and team building
  • Annual performance appraisal of the department
  • Make sure the internal processes are maintained with fewer complaints.
  • Adherence to regulatory requirements o Interdepartmental Coordination for smooth functioning of the department.
Statements and Reports
  • Assist in the preparation of timely and accurate departmental statements and reports to meet Al Koot and the respective department requirements, policies and standards.ÿ
  • Achieve Network expansion and negotiations
  • Regular monitoring to provider?s trend
  • Reprice the services in accordance to the market benchmark
  • Regular audit to the service codes submitted by the medical providers
  • Monitor and develop providers related systems
  • Regular Visiting to network hospitals and relationship management.
  • Interdepartmental Coordination for smooth functioning of the department

Keyskills :

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