Gerente Regional de Contratación de Proveedores
The Regional Providers Contract Manager is in charge of managing the network of providers in order to secure access, best value and the highest quality of care to Bupa’s customers. The Regional Providers Contract Manager needs to evaluate the current medical network, propose the necessary changes or enhancements that guarantee the best outcome from the relationships with the medical providers. The Regional Providers Contract Manager also identifies contracts and supervises new medical and ambulatory service providers required to support the development of new products in order to effectively control cost and medical fees according to company strategy.
- Develops and maintains effective medical provider contracting and claims cost management strategy in the countries assigned, ensuring alignment with the global providers strategy.
- Negotiates contracts with hospitals, doctors or any provider of medical and ancillary services in order to obtain cost effective fees that allow members access to quality healthcare at best possible cost.
- Implements internally and externally the negotiated contracts in order to assure the compliance of contracted terms and business relations expectations (rates, discounts, bundled payments, exchange rates, payment conditions, etc)
- Coordinates with other areas within the organization the implementation of corporate guidelines regarding Compliance, Clinical Governance, Hospital Quality Assessment and in general any policy related with medical providers.
- Analyses claims data to understand cost of medical services by country, provider and service line and proposes strategies to reduce medical expense.
- Develops and manages a provider network to ensure the delivery of high quality, customer focussed and cost effective healthcare to all Bupa members.
- Identifies and develops successful provider and strategic relationships, with Third Party Administrators, which improves service delivery, quality of care and value for money for members and the business.
- Pro-actively supports and coaches providers to strengthen relationships and facilitate accurate and efficient claims processing.
- Obtains feedback and recommendations from providers and escalates this information to the Head of Provider Purchasing to improve the level of service to our customers.
- Implements solutions to monitor claims paid to top contracted physicians to ensure discounted rates (fee schedule) and goals are being met through compliance.
- Reviews and monitors Bupa’s claim spend and procedures to ensure a high level of service efficiency and consistency with provider payment requirements. Maintains data of above to ensure timely payment of claims thus increasing provider satisfaction across the business.
- Supports the Business Unit in developing and/or improving operational procedures with Bupa sister companies in order to achieve a worldwide proposition to our customers when required.
- Supports and coaches new and existing employees in relation to negotiation and cost containment.
- Identifies and coordinates areas within organization that must act jointly to secure best financial value from negotiations.
- Pro-actively participate in the achievement of individual and team goals.
- Performs other related tasks and projects as assigned.
The Ideal Candidate
- 4 year College degree with extensive relevant experience in hospital and physician reimbursement, contracting and relations
- Extensive 5-7 years experience, preferably in international private medical insurance or contract negotiation
- Strong financial and analytical skills
- Proficient to expert use of Excel and Power Point
- Bilingual in Spanish and English – read, write and communicate effectively in both
- Good commercial knowledge of Latin America