Executive

Job Summary

We are looking for an Executive Provider Network to support the management and coordination of our healthcare provider network. The role will involve coordination with hospitals and healthcare providers, maintaining provider data, supporting empanelment activities, handling provider queries, and ensuring smooth network operations in line with company and insurer requirements.

Key Responsibilities

1. Hospital Empanelment & Network Management

• Coordinate with hospitals and healthcare providers for empanelment and onboarding.
• Collect and verify required hospital documents and credentials.
• Maintain accurate and updated provider/hospital master data.
• Coordinate for addition, modification, suspension, and de-empanelment of providers.
• Support expansion and strengthening of the hospital network as per business requirements.

2. Hospital Coordination

• Maintain regular communication with network hospitals regarding operational requirements.
• Address and coordinate resolution of hospital-related queries and concerns.
• Coordinate with hospitals for service-related issues, tariff updates, and operational requirements.
• Build and maintain professional relationships with network hospitals.

3. Rate & Contract Management

• Assist in coordination for hospital tariff negotiations and updates.
• Maintain records of agreed tariffs, packages, discounts, and contractual terms.
• Ensure timely updating of negotiated rates and agreements in the system.
• Coordinate with internal teams for implementation of revised tariffs.

4. Provider Data & Documentation

• Ensure completeness and accuracy of hospital documentation and records.
• Maintain provider contracts, agreements, licenses, registrations, and other required documents.
• Regularly update hospital details, specialties, contact information, and service availability.
• Support periodic review and validation of provider data.

5. Internal Coordination

• Coordinate with Claims, Operations, Medical, Customer Service, IT, and other internal teams for provider-related requirements.
• Support resolution of hospital-related operational issues.
• Provide required network information and reports to internal stakeholders and insurers.
• Escalate critical provider issues to the reporting manager within defined timelines.

6. MIS & Reporting

• Prepare and maintain regular MIS reports related to provider network activities.
• Track hospital empanelment, renewals, agreements, tariff updates, and other network-related activities.
• Maintain trackers for pending documentation, contracts, and provider requests.
• Ensure timely submission of reports as per defined timelines.

7. Compliance & Quality

• Ensure provider onboarding and documentation are completed as per organizational and regulatory requirements.
• Support periodic provider audits and data validation exercises.
• Ensure adherence to defined SOPs, SLAs, and process guidelines.
• Identify gaps in provider documentation or processes and coordinate for corrective action.

Key Skills Required

• Good communication and interpersonal skills.
• Strong coordination and negotiation skills.
• Good knowledge of MS Excel and MS Office.
• Ability to manage multiple hospital/provider relationships.
• Good follow-up and problem-solving skills.
• Ability to work with cross-functional teams.
• Attention to detail and accuracy in maintaining provider data.
• Knowledge of the TPA / Health Insurance / Hospital Network industry will be an advantage.

Educational Qualification

Graduate in any discipline. Candidates with a background in Healthcare Management, Hospital Administration, Insurance, or related fields will be preferred.

Preferred Experience

• 1–3 years of experience in Provider Network, Hospital Relations, TPA, Health Insurance, Hospital Administration, or Healthcare Operations.
• Freshers with strong communication and coordination skills may also be considered, depending on business requirements.