Manager – PR Contract Management

To accomplish contract administration, pricing & cost effectiveness and network design of the providers through the implementation of the agreed department action plans to achieve quality, accessible and affordable healthcare within the agreed timescalesContract Administration:Implement the set of contracts’uniformity and standards with all providers.Excute contracting new providers ,new service codes and the renewal of contracts in accordance with applicable guidelines and instructionsMaintain contracts’ compliance with the regulatory, renewals and licensing requirementsFollow up contracting administration to ensure timely processing and finalizationBenchmarking:Engage in the Identifying of frequently billed items according to providers distributionCollect price range for each frequent item per network according to providers distributionCollect prices/quotations for other items/services whenever needed (experienced) or requested.Support other business units in pricing services and itemsApply standard optical and dental pricing models.Implement the benchmarks and related guidelines in the providers’ agreements and pricingPricing ,Discounts and Codings:Implement the revamped coding systemsResolve the defaults of the invalid & duplicate service codes and overbilling with the assigned providersCoordinate, internally and externally, for the resolution of coding and pricing defaults.Engage in business obligations of ICD 10-am implementationEnsure that new prices ,contractsand amendments are uploaded in the operating systems.Ensure the implementation of discounts ,PPD and volume discountsCost Effectiveness:Identify items potential areas for price reductions to achieve business targets with the assigned providersIdentifyproviders andservices’ potential for bundling(in & out patients) and expansion of surgical packagesNegotiating price reductions and bundling with the assigned providersConduct studies for the financial impacts of proposal and agreements of new contracts/service codes and renewalsNetwork Design and management:Identify areas for potential network redesign to achieve business objectives of affordable care.Volume Allocation:Monitor the implementation of stepladder and referral systems with regular updates to achieve best practice and cost effectiveness.Identify providers fittingnetwork of anchors and centers of excellenceEngage in building partner relationship with strategic providersCoordination and Communications:Coordinate with the operating team and technical stakeholders to ensure the implementation of addition /deletion ofcontracts/providers ,amendments and significant contract milestone .Coordinate with provider relation and stakeholders targets & plans of negotiation.#J-18808-Ljbffr