Provider Network Manager

4 weeks ago


Manila, National Capital Region, Philippines ActiveOne Health, Inc. Full time

Job Objective / Purpose

Provider Network Manager supports the overall goals of Flexicare through the strategic growth of the network of partner doctors, medical and dental facilities. The incumbent manages the relationship with referral partners by way of consistent communication to identify needs and promote services. The Manager oversees provider contracts, credentialing and documentation, review of professional fees and medical cases of members.

Duties and Responsibilities

1. Network Development

Develops the provider network by contracting hospitals / doctors requested or referred by members and accounts management team.Negotiates with non-accredited doctors to accept Flexicare rate and eventually participate in Flexicare network.Evaluates current network reach and plans for expansion according to business needsEnsures that each accredited facility has the basic set of MD specialization to serve the needs of Flexicare members 2. Network Management Ensures harmonious relationship with accredited partnersManages agreed SLAs with partnersProactively organize provider network engagement events (e.g MD night), partner dialogues, etc.Review and assess standard professional fee rates and benchmark with industry standardsManages hospitalization expenses and reviews coverability according to benefit plan Background and QualificationsCandidate must be a Doctor of MedicineAt least 2 year(s) of solid working experience in the related field and with a successful track record required for this position.With experience working in TPA / HMO or insurance companies.At least Level 2 Computer Skill Literacy (Basic Computing and Applications)Knowledgeable in PHIC, ICD, CPT, RUV computationAbility to do on-site visits within Metro Manila and work on weekends and extend beyond company operating hours when needed. Excellent negotiation and account management skillsGood communication (written and oral), interpersonal, problem resolution and critical thinking skillsAbility to develop strong provider relationshipStrong organizational, multi-tasking and time-management skills.Proven ability to work independently and as a team memberAdheres consistently to the RCI values


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