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Network Services Liaison Officer

2 meses atrás

Paraná, Brasil International SOS Tempo inteiro
Overall Purpose of the Role

Focus: Provider Network Management

The QTC VA Program Network Services Liaison Officer is responsible for establishing the VA network in the designated countries. This role will contract and negotiate the pricing and contract terms with our providers.

Maintaining market pricing will be key to the success of this role, so on-going price negotiations, selection of new providers and exploring new commercial options for delivery of the service will be required.

It will also be responsible for enrolling, registering and managing the relationships with strategically selected providers to the QTC VA Network.

This position serves as the primary contact to an assigned QTC VA Network to ensure there is sufficient provider supply and availability to meet the demands of the program.

This position will develop and maintain provider relationships in the assigned territory to ensure network demands are met. This role will also be responsible for educating providers on processes, contract and performance requirements. It will operate as an intermediary between International SOS and Providers on education needs, while also assisting with facilitating resolution of escalated provider issues.

This is a front-line role, customer-facing and customer advocacy role responsible for engaging with providers pre- and post- agreement to participate in the network. The role will discuss and understand how the provider operates, administrative requirements to establish their provider file and the provider payment preferences. This includes delivery of any provider training and supporting the ongoing day-to-day service delivery for providers within the defined portfolio.

Key Responsibilities

Specific Responsibilities

  • Identification, negotiating price, contracting, and onboarding of providers to ensure they meet the requirements set for the QTC US Veteran Programme.
  • Ensure that the provider data and credentials are kept up to date in SPIN system, compliant with Group Network Services Standards and Procedures.
  • Manage new provider partnerships including price negotiation, collection of key provider file information for the provider file set up and ensuring a comprehensive understanding of the provider preferences for participation under the programme (Relationship Management “RM”).
  • Serve as a primary point of contact for provider network issues and resolution (RM).
  • Interact with Network Services, WorkSafe and Government Services leadership to discuss network demands, validate network issues and resolve network gaps.
  • Monitor assigned area against established network adequacy and access standards; identify network gaps and track shortfalls through capacity tools; translate gaps into recruitment targets.
  • Develop a commercial network development plan in partnership with the VA Program Network Manager.
  • Establish and maintain positive working relationships with all customers; responds to emails, phone calls, customer service inquiries by fully researching the inquiry and responding promptly.
  • Communicate and assist with resolving escalated care issues related to provider network issues; utilize resources and tools to resolve escalated issues; document access to care issues.
  • Conduct operational and medical training as needed with providers related to compliance requirements, programs, and processes; recommend future provider educational needs based on observations and discussions with providers and questions raised during live and web-based training (RM).
  • Provide feedback to management about claims processing, referral/authorization, or other unfavorable trends from provider interactions (RM).
  • Deliver periodic status reports.
  • Manage day-to-day relationships and region-specific needs of assigned provider base.
  • Provide feedback and input to provider support materials (RM).
  • Engage in regular provider visits across the region (RM).

Customer & Provider Relationship Management

  • Be accessible and responsive to clients, providers and colleagues’ questions, concerns and requests for information.
  • Deal positively with internal/external complaints, including those from providers and members; these are to be resolved wherever possible in a timely manner, or referring them to the appropriate department/Network Services/Management.
  • Maintain a courteous and professional manner at all times when dealing with service providers, customers and colleagues.

Liaison

  • Establish responsive liaison arrangements both within International SOS and externally.
  • Positively promote International SOS to other organizations and providers.
  • Be accountable to the Managers regarding workload and issues.

Other Duties

  • To attend supervision, training and meetings as and when required (there may be a necessity for these to sometimes be outside normal working hours).
  • To work within and promote all International SOS policies and procedures.
  • To carry out any other reasonable duties as requested by the Managers.
Required Qualifications

Required Skills and Knowledge

  • Knowledge of local provider networks and the business relationship between providers and beneficiaries.
  • Ability to negotiate pricing and contracting with a provider network.
  • Proficient with data entry and provider database systems; proficient with Microsoft Office products including Outlook and Excel.
  • Ability to solve problems through systematic analysis of processes and application of judgment.
  • Ability to organize people/tasks, adjust to priorities, learn systems, within time constraints and with available resources, detail orientation.
  • Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Required Work Experience
  • Previous experience within the healthcare sector, preferably in a commercial provider management role highly preferred.
  • Customer Service.
  • Ability to negotiate.
  • Or equivalent Military Experience.
Required Qualifications
  • Bachelor’s Degree or equivalent.
  • Work experience in a Customer Service environment.
Required Languages
  • Fluent in English.
  • Fluent in Spanish.
Job Conditions
  • Travel required.
  • To work at other Intl.SOS locations as and when required (job condition).
  • To work flexible hours as appropriate to the needs of the post.

This job description outlines the types of responsibilities the incumbent is required to perform. The incumbent may be required to perform job related tasks other than those specifically presented in this job description. This job description is subject to regular review.

International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.

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