Job Description: Medical Officer - Provider Management
Position Summary:
We are seeking a highly motivated and detail-oriented Medical officer to join our team and play a critical role in ensuring for a range of activities focused on managing and expanding Medi Assist's network of empanelled hospitals, ensuring compliance and adherence to agreed terms, and promoting wellness initiatives for corporate clients. The candidate has to possess a strong understanding of healthcare billing procedures, tariff structures, and claims adjudication, with a proven ability to identify and address billing abuses and tariff violations. This role requires excellent communication and negotiation skills, as well as the ability to effectively interact with hospital administrators and internal stakeholders to drive process improvements and ensure compliance.
Key Responsibilities:
Network Activity:
- Hospital Empanelment and Contracting:
- Conduct physical and virtual audits of hospitals to assess their suitability for empanelment within the Medi Assist network.
- Facilitate the process of contracting new hospitals, including negotiation of terms and finalization of agreements.
- Manage the on boarding process for new hospitals joining the network.
- MOU and Tariff Management:
- Ensure timely renewal of Memorandums of Understanding (MOUs) with empanelled hospitals.
- Maintain and update Medi Assist packages and tariffs in accordance with agreements.
- Verify the validity of MOUs and tariffs to ensure accurate and compliant billing practices.
- Communicate any changes or updates to MOUs and tariffs to relevant stakeholders.
Network Audit:
- Regular Hospital Visits:
- Conduct timely and regular visits to network hospitals as per the defined schedule.
- Billing Practice Verification:
- Thoroughly verify the billing practices of network hospitals to ensure adherence to agreed packages, tariffs, and MOUs.
- Identify and report any discrepancies or potential issues in billing.
- Provide feedback to hospitals on billing compliance and best practices.
Wellness Activity:
- Health Camp and Health Check-up Arrangement:
- Coordinate and arrange health camps and health check-up programs for corporate clients.
- Liaise with network hospitals and corporate clients to plan and execute wellness activities.
- Ensure the smooth and efficient delivery of wellness initiatives.
Qualifications:
- Bachelor's degree in BAMS/BHMS/healthcare administration, business administration, or a related field.
- Minimum of 3-5 years of experience in healthcare claims processing and hospital billing analysis.
- Fluency in Telugu and English.
Key Skills and Competencies:
- Robust understanding of hospital operations, billing practices, and healthcare regulations.
- Excellent auditing and analytical skills with a keen eye for detail.
- Proven negotiation and relationship management abilities.
- Effective communication (both written and verbal) and interpersonal skills.
- Strong organizational and time management skills with the ability to prioritize tasks.
- Proficiency in MS Office Suite (Word, Excel, PowerPoint).
- Ability to work independently and as part of a team.
- Problem-solving and decision-making skills.
- Customer-centric approach.