ROLE PURPOSE:

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 timescales.

KEY ACCOUNTABILITIES:

1. Contract Administration

• Implement the set of contracts’ uniformity and standards with all providers.

• Execute contracting new providers ,new service codes and the renewal of contracts in accordance with applicable guidelines and instructions.

• Maintain contracts’ compliance with the regulatory, renewals and licensing requirements.

• Follow up contracting administration to ensure timely processing and finalization.

2. Benchmarking

• Engage in the Identifying of frequently billed items according to providers distribution.

• Collect price range for each frequent item per network according to providers distribution.

• Collect prices/quotations for other items/services whenever needed (experienced) or requested.

• Support other business units in pricing services and items.

• Apply standard optical and dental pricing models.

• Implement the benchmarks and related guidelines in the providers’ agreements and pricing.

3. Pricing,Discounts and Codings

• Implement the revamped coding systems.

• Resolve the defaults of the invalid & duplicate service codes and overbilling with the assigned providers.

• Coordinate, internally and externally, for the resolution of coding and pricing defaults.

• Engage in business obligations of ICD 10-am implementation.

• Ensure that new prices,contracts and amendments are uploaded in the operating systems.

• Ensure the implementation of discounts,PPD and volume discounts.

4. Cost Effectiveness

• Identify items potential areas for price reductions to achieve business targets with the assigned providers.

• Identify providers and services’ potential for bundling(in & out patients) and expansion of surgical packages.

• Negotiating price reductions and bundling with the assigned providers.

• Conduct studies for the financial impacts of proposal and agreements of new contracts/service codes and renewals.

5. Network Design and management

• Identify areas for potential network redesign to achieve business objectives of affordable care.

6. Volume Allocation

• Monitor the implementation of stepladder and referral systems with regular updates to achieve best practice and cost effectiveness.

• Identify providers fitting network of anchors and centers of excellence.

• Engage in building partner relationship with strategic providers.

7. Coordination and Communications

• Coordinate with the operating team and technical stakeholders to ensure the implementation of addition /deletion of contracts/providers,amendments and significant contract milestone .

• Coordinate with provider relation and stakeholders targets & plans of negotiation.