Define empanelment process, finalizing communication material
Identify and empanel hospitals, clinics, diagnostic centers, and other healthcare providers to join the network.
Defining categories of hospitals, grading and appropriately mapping
Maintain hospital network master with clean data and appropriately flag suspected hospitals
Analyze market trends, insurance company and client requirements and geographical spread to identify potential gaps in the network.
Evaluate the quality of healthcare providers based on accreditation, facilities, and medical staff credentials.
Negotiate contracts, package rates and discounts with healthcare providers to ensure competitive pricing while maintaining quality standards.
Collaborate with legal and compliance teams to draft and finalize contracts that meet regulatory requirements and protect the interests of the TPA and its clients.
Build and maintain strong relationships with hospital administrators, medical directors, and key stakeholders to facilitate seamless cashless claims management
Coordinate and help cashless team in the events of disputes at the time of admission/discharge of members regarding billing by hospital
Address and resolve any issues or concerns raised by network providers promptly and professionally.
Implement performance metrics to assess the efficiency and quality of services provided by network hospitals.
Continuously assess the network's adequacy and identify opportunities for expansion or optimization.
Collaborate with the business development team to align network growth with the TPA's strategic objectives and market demands.
Ensure that the network hospitals comply with relevant state & central govt registrations and accreditation requirements.
Stay updated with changes in healthcare policies and regulations that may impact the network.
Analyze network performance data and generate reports for management to assess the network's effectiveness and make informed decisions.
Close coordination with insurers on the network hospital management including empaneling hospitals as per the requirements of insurers.
Managing the team working for network hospital management across locations.
Defining the guidelines for hospitals visits and monitoring recording and maintenance of hospital visits
Constant monitoring of hospitals claims outstanding and coordinate with respective internal stake holders for payment of claims
Adhering to IRDAI guidelines w r t to de-empanelment process.
Close coordination with claims team on fraud and abuse control and initiation of appropriate action against hospitals involved in malpractices.
Constantly comparing the network hospitals count and rates with competition and taking appropriate measures to be best in the industry.
Important Note:
Health Insurance / TPA
Profile only eligible.
Interested candidate can send your updated resume to
careers@linkktpa.com.
Job Types: Full-time, Permanent
Pay: ₹55,000.00 - ₹65,000.00 per month
Benefits:
Cell phone reimbursement
Paid sick time
Provident Fund
Work Location: In person
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