Jobs

Total Health Trust Limited Vacancy for a Provider Management Executive

Jan 2, 2016, 11:22 AM
Total Health Trust Limited

Total Health Trust Limited - Our organization is a leading and largest health maintenance organization (“HMO”) in Nigeria with over 270,000 members and over 270 private corporations
representing some of the country’s top local and international multinationals, as well as public sector institutions under our management. We were the first HMO to be registered in Nigeria and 17 years later, we are still number one in the market. We are one of the very few HMOs that can boast the financial and technical backing of a world class company – Liberty Health (a member of the Liberty Group). The organization further prides itself with its rich culture of Respect, Compassion, Pride and Expertise.

Job Title: Provider Management Executive

Job Description:

To conduct hospital visit, inspection, accreditation, re-accreditation, education, claims audit, fraud detection, clinical audit, investigation of member’s related queries, resolve issues of short-payments as the need arise
Update providers register under schemes and share updates with concerned departments
Provide detailed provider management report
Ensure that all critical areas that require improvement that contribute to the success of the strategy are identified and communicated to the team lead.
Ensure prompt registration and processing of providers’ contracts on Medware.
Implement provider management strategies for organizational growth, competitiveness and leadership
To reconcile provider account received from the geographical regions assigned as well as any other delegated by the team lead.
Organize and carry-out product, policies and processes training in-house for group of providers in assigned geographical areas.
To negotiate with doctors and other health care providers about health care for clients
Liaison with NHIS
Represent organization in the health care events

Requirements:

Candidate must be a registered nurse, midwife and possess B.Sc. Nursing
Additional medical qualification will be an added advantage
Candidate must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes.
Excellent organizational, communication (verbal and written) skills and attention to detail
Candidate must have minimum of 5 years post-nursing qualification experience including 3 years in similar role in a Health Maintenance Organization (HMO).
Candidate must have Clinical experience

Other requirements: