Apr 9, 2025

Provider Network Manager

Location

MRT Sutthisan

Salary

40,000 - 60,000 THB

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Job Descriptions

1. Network Expansion & Optimization: • Develop and implement strategies to expand and strengthen BlueVenture TPA’s provider network. • Identify potential healthcare providers (hospitals, clinics, pharmacies, diagnostic centers) for partnership. • Negotiate contracts with new providers to ensure competitive pricing and service quality. 2. Contracting & Fee Negotiation: • Conduct negotiations on tariffs, discount structures, and service agreements with healthcare providers. • Regularly review and renegotiate contracts to align with market trends and cost-control strategies. • Ensure that contract terms comply with regulatory requirements and business objectives. 3. Relationship Management & Provider Engagement: • Act as the primary liaison between BVTPA and network providers to ensure smooth collaboration. • Address provider concerns, resolve disputes, and improve service efficiency. • Conduct regular provider meetings, workshops, and training sessions. 4. Performance Monitoring & Quality Assurance: • Establish KPIs to monitor provider service quality, turnaround time, and claims efficiency. • Implement provider audits to assess compliance with contract terms and service standards. • Work closely with internal teams to analyze provider performance data and recommend improvements. 5. Claims & Billing Coordination: • Ensure that providers follow the agreed billing process to minimize claims disputes. • Collaborate with the claims processing team to resolve billing discrepancies and payment delays. • Support automation initiatives to improve claims submission and payment turnaround times. 6. Market Research & Competitive Benchmarking: • Monitor market trends in provider tariffs, reimbursement models, and emerging healthcare services. • Conduct benchmarking analysis to maintain a competitive and cost-efficient provider network. • Provide insights on market developments and recommend adjustments to network strategies.

Qualifications

Education: Bachelor’s or Master’s degree in Healthcare Management, Business Administration, or a related field.
Experience: Minimum 5-7 years in provider network management, healthcare administration, or a similar role in TPA, health insurance, or hospital networks.
Strong contract negotiation and provider relationship management skills.
In-depth knowledge of healthcare pricing models, reimbursement structures, and claims processing.
Understanding of regulatory frameworks affecting provider networks and health insurance.
Data analysis and reporting skills to assess provider performance.
Proficiency in AI-driven healthcare analytics (preferred).
Excellent communication, stakeholder management, and problem-solving skills.
Language: Fluency in Thai and English is required.