Job Description

Job Category: Administration
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Responsibilities:
Key Responsibilities
1. Strategic Relationship Management

• Act as the primary point of contact for all payer and funder accounts.
• Build and maintain strong, collaborative relationships with insurance companies, TPAs, and government payers.
• Conduct regular review meetings with funders to resolve issues, share performance insights, and align on strategic initiatives.

2. Contracting & Negotiations

• Lead contract negotiations with payers (fee-for-service, bundled payments, capitation, PMPY, value-based care, etc.).
• Evaluate reimbursement models, propose risk-sharing arrangements, and ensure financial viability for the hospital.
• Monitor contract performance and initiate renegotiations to optimize terms.

3. Claims & Reimbursement Oversight

• Collaborate with the revenue cycle team to track claim submissions, denials, and payment trends.
• Escalate unresolved disputes with payers to ensure timely resolution.
• Closely work with Reconciliation team and support in case of delayed dues.

4. Compliance & Policy Alignment

• Stay updated on payer policies, regulatory guidelines, and healthcare financing trends in the region.
• Ensure hospital services are aligned with insurance coverage criteria to avoid compliance risks.
• Educate internal stakeholders (clinical and billing teams) on payer-specific requirements.

5. Business Analytics & Reporting

• Analyze payer performance, revenue contribution, and contract profitability.
• Provide regular dashboards and insights to leadership on payer mix, utilization patterns, and financial outcomes.
• Identify opportunities for growth (new product/service coverage, enhanced network inclusion, etc.).

6. Cross-functional Collaboration

• Work with clinical teams to support implementation of value-based care initiatives and care pathway alignment.
• Partner with marketing/business development for new payer partnerships.
• Support finance and strategy teams in developing forecasts and budgets based on payer contracts.

Qualifications:
Qualifications & Experience

• Bachelor's degree in Healthcare Management, Business Administration, Finance, or related field.
• 6-10 years' experience in healthcare provider-payer relations, revenue cycle, or contracting (hospital/insurance sector).
• Strong knowledge of healthcare financing models (FFS, DRG, bundled payments, risk-based contracts, capitation).
• Excellent negotiation, analytical, and communication skills.
• Familiarity with UAE healthcare regulatory frameworks and payer ecosystems

Skills Required