Provider Network Consultant – Medical Aid – R24 to R31 000.00 CTC- Cape Town
New and exciting vacancy available at this forward thinking and dynamic medical aid organisation based in Cape Town. Seeking the services of a professional and dedicated provider network consultant. Well spoken, organised and reliable. Excellent career prospects and opportunity for growth both personally and professionally.

Scope of responsibility:
? Develop integrated networks with quality providers yielding a geographical competitive, broadly accessible, stable network that achieves company objectives.
? Evaluate practices in analysing member care, trend quality compliance at provider level.
? Develop action plans and programs to support provider practices in continuous quality improvement using approved guidelines.
? Responsible for provider education, contract compliance, and resolving provider concerns and issues
? Negotiate all Provider Network, casualty and Hospital contracts on an individual basis and or groups
o (IPA’s and discipline specific groups) where appropriate.
? Partner with internal stakeholders to create a seamless experience for providers.
? Ensure all enquiries are resolved satisfactorily and customer requirements within business rules
? Do continuous risk management of all providers and take action in areas where costs are exuberant
? Identifies and resolves network access gaps or perceived gaps.
? Supply monthly management reports
? Must be able to travel to all providers
? This position requires extensive travelling.

Previous qualifications skills and experience:
? Matric.
? At least 4-5 years’ experience in a similar role
? Sound understanding of the South African Health industry, options and benefits etc.
? Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.
? Meeting targets and regulatory requirements.
? Must have experience in working with all provider types and understand how providers administration systems work in order for claims to be submitted.
? Must have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issues.
? Excellent oral and written communication skills
? Computer literate - MS Office suite, i.e. Word and Excel a must
? A good understanding of claims risk profiling
? Own reliable transport and valid drivers licence

Clear criminal record, ITC and contactable previous employment references are essential. Please mail a comprehensive CV