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This Provider Administrator Job description helps candidates understand the duties, responsibilities, skills, and competencies necessary for success in the role. Recruiters often customise these criteria to attract suitable candidates for these positions.

Job Title: Provider Administrator

Job Objective(s):  

• Provider prospecting through visits, phone calls, and emails
• Documentation and filing of prospective and available providers
• Managing the Call Centre and issuing authorization codes as needed
• Conducting provider quality assessments
• Case management

Reporting Relationship:

• Reports to: Head, Medical Operations
• Supervises: Front desk staff

 

Job Responsibilities

1. Provider Identification, Profiling, and Activation Management: Responsible for maintaining accurate filing and record-keeping.

2. Provider Visitation, Audit, and Capacity Evaluations: Conduct evaluations to assess provider capabilities and compliance.

3. Assistance with Provider Tariff Review and Negotiation: Support the review, negotiation, and implementation of tariffs for prospective providers.

4. Provider Network Quality Assurance: Assess quality, ensure profitability, and categorize provider networks accordingly.

5. Coordination of Care Access and Referral Mechanisms: Manage the processes for accessing care and making referrals.

6. Promotion of Positive Relationships: Foster strong relationships between clients and providers.

7. Provider and Client Education: Facilitate educational initiatives and awareness for both providers and clients.

8. Provider Satisfaction Surveys: Conduct surveys to gather feedback and analyze provider satisfaction.

9. Scouting and Activating New Healthcare Providers: Identify and activate new healthcare providers, maintaining all filing systems in both digital and hard copy formats.

10. Call Center Support: Handle calls at the call center and provide email approvals for procedures or issue verbal pre-authorization codes as needed.

11. Additional Responsibilities: Undertake any activities assigned by management.

Units Under Provider Administration

• Provider Management
• Call centre

Competence Requirements:

Core Skills:

• Planning and Strategy
• Provider prospecting
• Provider management
• Document filing and record-keeping
• Provider visitation
• Research
• Decision-Making Skills
• Negotiation Skills
• IT Applications in business and customer service

Generic Skills

• Organisation Context
• Leadership
• Communication
• Presentation Skills
• Relationship Management Skills
• Emotional Intelligence
• Analytical skills
• Interpersonal Skills:
• Environmental awareness
• Performance Management
• Office productivity IT tools
• Fiscal Management

Specification/Qualification Requirement:

• A bachelor’s degree is required, and a master’s degree is an advantage.

Experience Required:

• Minimum of 2 years of post-qualification experience in a similar role within a Health Maintenance Organisation (HMO) or managing the HMO desk in a hospital.

Professional Membership:

• A professional qualification in Management is an added advantage

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