We seek an experienced and professional individual that will take the mantle of the Senior Manager, Health Service, Network Management who will be responsible for establishing the strategy, creation, direction and evolution of the provider network. The incumbent shall liaise with providers and conduct ongoing network performance to ensure a complete, stable, accessible well-regarded and high quality delivery system as well as reviewing the overall workflow of the Health Services functions to streamline the procedures as necessary.

Main responsibilities:

The position is to supervise and lead team members in the execution of the functions of Network Management Services as well as the performance of functions that are categorized as the following:

- Setting up and maintaining provider network
• Initiating and maintain network provider for health services.
• Administering credentialing process and operation of network provider.
• Establishing working procedure as well as identifying control process for compliance to ensure service standards.
• Accomplishing the requirement for panel network to perform eligibility check and EDI claims submission for accuracy and efficiency.
• Conducting facility visits for ensuring accuracy in panel system setup and administration and service quality at clinic
• Monitoring network adequacy
- Reviewing network provider quality by:
• Reviewing daily call log on network provider (both corporate and life products) for the purpose of identifying areas for improvement.
• Providing recommendations to network providers after an investigation of reported servicing issue including both corporate and life products arrangement.
• Monitoring network provider’s performance within the established service standard
• Conducting regular meeting with Panel Network for utilization review and service excellence and plan for service improvement
• Planning and monitoring timeline for fee schedule discussion and negotiation.
• Identifying problems which affect the Network and proactively communicate with management for improvement plan
- Contributing to network proposal for service arrangement or product development by:
• Identifying network provider combination by customer needs.
• Coordinating and negotiating network provider to submit a proposal.
• Preparing standard workflow, requirement and administrative guideline for implementation.
• Recommending and executing a methodology for eligibility check including IVRS, IEC, WEC and Panel File with an explanation on specifications.
• Conducting pre and post service review for improvement.
- Reviewing workflow and system capabilities for efficient delivery of health services to clients and system interface with business partners by:
• Reviewing system performance and identifying areas for the technical support team to monitor stability.
• Reviewing system for enhancement of efficiency and convenience for clients.
• Reviewing system capability for eligibility via IVRS, IEC, WEC for identification and other checking alternatives.
• Reviewing overall current workflow and streamline as necessary

- Other duties and responsibilities could include:

• Checking and looking for appropriate providers for the provision of health care services for customer satisfaction enhancement.
• Planning and designing tailor made health check and other wellness programs.
• Planning and designing value added services for clients as required.
• Being responsible for leading the Provider Management strategy in Project Care, other project initiatives and other projects relating to service or system enhancement
• Other duties and responsibilities that might be assigned by the supervisor.
Education:
- A university degree in Business Studies, Health Administration or relevant disciplines.

Skills and experience:

- A minimum of 8 – 10 years relevant experience with at least five years in the private healthcare industry and EB insurance benefits.
- Customer service and presentation experience are highly required.
- Strong business communication, analytical, planning, problem solving, documentation and organizational skills.
- Knowledge of Healthcare delivery, performance monitoring, electronic billing, medical service practice, industry practice, related ordinance, and governance.
- Proficiency in both spoken and written Chinese and English.
- Strong communication and negotiation skills.