Negotiation Team - Provider & Networking

HealthIndia Insurance TPA Services

5 - 8 years

3 - 5 Lacs

mumbai suburban

Posted:1 day ago| Platform:

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Skills Required

provider network negotiation tpa provider management hospital empanelment broker insurance

Work Mode

Work from Office

Job Type

Full Time

Job Description

Role Overview:

The role is responsible for handling tariff negotiations with network hospitals, addressing cases where providers are violating agreed tariff terms, ensuring compliance with insurer/PPN guidelines, and protecting the organization from revenue leakage and penalties.

Key Responsibilities:

Monitor and identify tariff violations by hospitals in coordination with cashless and claims teams.
Engage with hospitals to negotiate and enforce agreed tariff structures.
Escalate repeated non-compliance cases to higher management/insurers for action.
Maintain strong relationships with hospital administrators to ensure cooperation.
Document all negotiation outcomes and update tariff records in the system.
Support audits and provide MIS on tariff compliance and deviations.
Coordinate with insurers for approvals on special tariff requests or escalations.
Assist in empanelment reviews and ensure tariff adherence during renewals.

Key Performance Indicators (KPIs):

% of tariff violation cases resolved successfully.
Reduction in revenue leakage due to tariff deviations.
Number of negotiations closed within defined TAT.
Hospital satisfaction vs. compliance balance.
Accuracy and timeliness of tariff documentation.

Qualifications & Experience:

Graduate/Postgraduate in Healthcare, Management, or related field (medical/paramedical background preferred).
58 years of experience in provider management/networking in TPA or health insurance.
Strong negotiation and relationship management skills.
Knowledge of PPN guidelines, hospital billing practices, and health insurance tariffs.

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