Gems Vacancies Cape Town – Provider Liaison Officers

Job Description:
The Provider Liaison Officers will report directly to the Senior Manager: Networks and Provider Relations and forms part of the Healthcare Management Division.
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Job Responsibilities:

Perform a secretariat function for the provider relations engagements.
Provide substantiated commentary on the quality of network services and provider compliance to the Scheme network agreements.
Provide substantiated commentary on the quality of network services and provider compliance with Scheme network agreements.
Support the Senior Manager: Networks and Provider Relations in maintaining the GEMS relationship with healthcare providers within assigned region.
Fulfil various stakeholder engagements as directed by the Chief Healthcare Officer.
Participate in the review and submission of GEMS networks reports- Support the Senior Manager:
Networks and Provider Relations in the management of the Managed Care Organisations that are contracted by the Scheme.
Support other Scheme Division's in managed care activities.
Participate in the review of the providers efficiency reports.
Provide periodic reports relating all stakeholder engagements to the Senior Manager: Networks and Provider Relations.
Represent the Healthcare Management Division at SPN and Stakeholder Engagements and promote network participation by healthcare providers.
Serve as a single point of contact for escalations related to claims and authorizations issues from the providers within the assigned region.
Ensure continuous education on GEMS strategy, systems, processes and product to the relevant providers within the assigned region.

Job Requirements:

At least 5 years work experience in the healthcare funding/medical scheme industry.
Be a self-starter.
Must have experience in provider relations management.
Excellent communication and writing skills.
Must have experience in the development and presentation of management reports- Computer literacy and MS Office skills.
Own transport essential.
Have ability to work well as part of a team.
Have sound planning/project management skills.
At least a 3 year Diploma/Degree or equivalent NQF level in Clinical Sciences related fields.
Have diligent work ethics with attention to detail.
Experience in case/ claims management will be advantageous.
Be responsible and reliable.
Sound Quantitative and qualitative analysis skills with ability to manage priorities.

Job Details:
Company: Government Employees Medical Scheme – GEMS
Vacancy Type:Full Time
Job Location: Pietermaritzburg
Application Deadline: N/A
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