PROTECTHEALTH CORPORATION SDN. BHD. is looking for new potential candidates to fill in for Executive, Provider Management position. If you currently looking for new healthcare job opportunities and qualified with the job desc, feel free to apply this job.
Provider Payment Mechanisms & Provider Management is responsible for identification of most effective payment methods depending on the target population and benefit package coverage of the target population. It is also responsible for identifying and evaluating opportunities, negotiating optimal provider payment and reimbursement rates, drafting contracts for an assigned provider or provider network, and providing oversight of the contract management process to ensure patient access to the highest quality, cost-effective and responsive healthcare services, in accordance with applicable regulations and the Company's policies, practices and procedures.
- Support the department to identify, design and develop suitable provider payment mechanism (PPM) that promotes cost-effectiveness and ensures excellent quality of healthcare delivery.
- Work closely with Legal to design and develop provider contract standards consistent with the Company’s objectives and policies as well as relevant regulatory requirements.
- Ensure all contracting done in line in compliance with relevant policies, standards, guidelines, and operating procedures.
- Maintaining the legal interaction with the provider(s)/supplier(s) that the company will deal with.
- Working in collaboration with the Strategic Purchasing Department (SPD) to develop the contracting priorities.
- Conduct contract strategy meetings in collaboration with SPD to identify issues and provider requirements, facilitate pricing discussions, and obtain senior management input on timelines and deliverables.
- Ensure compliance with established policies and procedures, regulatory requirements, and mandatory training requirements to enable efficient PPM implementation.
- Assist to develop supplier(s)/provider(s) agreements/contracts by working with cross-functional stakeholders and suppliers to reach agreement on contract terms and conditions.
- Assist in establishing short-term and long-term planning and budget development of the company to support strategic business goals.
- Support the developing processes and procedures to facilitate claims services.
- Handling complaints/issues regarding providers, and working close with Quality Assurance Department.
- Developing/ negotiating/ monitoring healthcare service provider’s agreements.
- Partner with other relevant departments to conduct analyses and market trends in order to identify, develop, and implement competitive PPM and reimbursements as well as to develop contracts.
- Continuously improve productivity and efficiency of processes throughout the operational organization.
- Develop forecasts for future demand and institute appropriate intervention pertaining to PPM & PM in a timely manner based on data evidence.
- Negotiate provider contracts to support penetration relative to Company’s strategic direction, competitive market trends and providers expectations.
- Maintain, and preferably exceed, contracting production and quality standards that emphasize on principles of integrity and compliance.
- A Bachelor’s degree preferably in medicine, pharmacy or related field.
- Preference with a minimum of 3 years working experience in Takaful / Insurance / TPCA / Healthcare industry.
- Ability to manage multiple tasks and meet demands of a fast-paced environment with changing priorities.
Incorporated on 19 December 2016, ProtectHealth Corporation Sdn Bhd (ProtectHealth) is a wholly-owned subsidiary of ProtectHealth Malaysia, established under the Ministry of Health, Malaysia (MOH).
As a not-for-profit company, ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services as mandated by MOH.
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