Sr. Executive - Provider Management

Role & responsibilities

• Network utilization mapping for MDIndia Servicing and non servicing IC offices /locations.
• Cashless utilization of existing network hospitals and improvement in non utilized network hospitals.
• Review and improvement of Claims reported as reimbursement from network hospitals also no claim reported in last two financial years.
• Network hospitals MOU/SOC/discount negotiation/packages/Grievance/issues resolution.
• Value added services from network providers for corporate clients/IC offices like health check ups, additional discounts, health camps etc.
• Contact details network hospitals and relationship management with senior management/TPA desk and other officials.
• Comparison of SOC and list of network providers with other TPAs and Pvt ICs.
• Conversion of non network hospitals on cashless panel IFA/documentation/SOC/discount etc and approval of insurance companies.
• Reconciliation of pending /deducted payments.
• Priority for empanelment based on claims volume as reimbursement/IC office serviced by MDIndia/all corporate hospitals/all trust hospitals/all hospitals of Pvt ICs.
• Participation in IC Provider Management meetings and support for tri party /PPN networking done by respective IC.
• Training and support for new provider on documentation and process of authorization.
• MDI HO provider team lesioning and support.
• Hospital audit/IFA for the first claim reported as reimbursement.
• De listing /black listed hospitals database of other ICs and ongoing instruction from servicing offices.

( Interested candidates please share your resume to recruitment1@mdindia.com )