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Hospital Panel Management Specialist
1 week ago
About the Role:
The Network & Provider Management Consultant plays a key part in managing hospital panel partnerships, provider engagement, business development, and cost management initiatives.
This role is responsible for ensuring quality healthcare provider networks, optimizing cost strategies, and driving patient steerage toward preferred providers.
Roles & Responsibilities:
- Panel Provider Partnership Management:
- Assess new panel provider applications and provide recommendations based on credentialing guidelines.
- Support the Hospital Specialist Review Committee by coordinating documentation and site visits.
- Develop Performance Dialogue presentation decks using internal dashboards/information to ensure providers are updated with AIA's direction, change of processes, and aligned with AIA goals.
- Monitor provider behavior and evaluate hospital panel performance based on claims utilization, market best practices, service levels, fee schedule adherence, and fraud detection.
- Provide feedback and drive mutual improvement initiatives with providers.
- Oversee the handling of complaints from internal and external clients related to provider services, claims, and guarantee letter (GL) turnaround times (TATs) and service level agreements (SLAs).
- Track and ensure swift resolution of claims and GL issues through operations meetings and interventions.
- Conduct training sessions and communicate with panel providers on new procedures and operational updates.
- Build strong, win-win business relationships with healthcare providers.
- Develop and distribute marketing materials to promote Preferred Providers and drive patient steerage.
- Strengthen collaboration between agencies, corporate clients, and Preferred Providers.
- Drive steerage initiatives to Preferred Providers.
- Manage the allocation and promotion of health events to Preferred Providers.
- Support the execution of the Network Strategy to achieve medical inflation targets.
- Support special projects that drive significant savings and improve medical cost management.
