Build and expand Maxicare's physician network by sourcing, evaluating, and accrediting qualified healthcare providers.
Review physician applications and documentary requirements to ensure compliance with accreditation standards.
Negotiate physician contracts while ensuring alignment with company policies, industry regulations, and risk management guidelines.
Coordinate with Legal, Finance, Operations, and other internal stakeholders to facilitate contract preparation, review, execution, and renewal.
Manage physician relationships by serving as the primary point of contact for contract, claims, payment, and policy-related concerns.
Conduct regular provider visits to strengthen partnerships, address issues, and ensure high levels of physician engagement and satisfaction.
Monitor physician performance and prepare performance evaluation reports with corresponding recommendations.
Resolve provider concerns related to claims processing, reimbursements, contract renewals, and operational issues.
Facilitate timely resolution of balance billing and delayed discharge cases arising from physician excess fees.
Implement provider engagement and development initiatives to strengthen long-term collaboration with partner physicians.
Conduct market and industry research to identify opportunities for network expansion and improve provider relations strategies.
Maintain accurate provider records, contracts, and accreditation documentation.
Prepare reports, presentations, and analyses to support management decision-making.
Ensure compliance with healthcare regulations, company policies, and contractual obligations.
Perform other duties assigned by management.
Qualifications
Bachelor's degree in Business Administration, Healthcare Administration, Marketing, Nursing, Medical Technology, or any related field.
Strong knowledge of provider relations, contract administration, or healthcare network management is an advantage.
Excellent negotiation, communication, and relationship management skills.
Strong analytical and problem-solving abilities.
Proficient in Microsoft Office applications (Excel, Word, PowerPoint).
Ability to work independently and manage multiple priorities.
Willing to travel within the Baguio and Northern Luzon area for provider visits.
Must possess excellent interpersonal and stakeholder management skills.
Experience
At least 2–4 years of relevant work experience in Provider Relations, Account Management, Healthcare Operations, Medical Provider Network Management, Business Development, or Contract Management.
Experience in the healthcare, HMO, hospital, insurance, or pharmaceutical industry is highly preferred.
Experience in negotiating contracts and managing healthcare provider relationships is an advantage.
Proven experience coordinating with physicians, hospitals, or healthcare institutions.
Experience handling customer concerns, provider concerns, or stakeholder engagement is preferred.
