Walk-in | Senior Manager / Manager - Provider Network

Medi Assist; Ernakulam, Chennai District; On-site; INR 1,200,000 - 2,400,000; Full time

Job summary

Medi Assist is seeking a strategic Provider Relations leader to strengthen the network and ensure seamless cashless workflows across hospitals and diagnostic centers. The role focuses on network expansion, tariff negotiation, provider governance, operational integration with Claims and IT, and leadership to build a compliant, high-performing team across target zones.

You will drive credentialing, ensure NABH/JCI or local standards, and supervise provider manuals while aligning with IRDAI

Responsibilities

• Identify geographic and specialized care gaps to drive provider empanelment.
• Lead negotiations on tariffs, package rates, and terms to optimize costs.
• Serve as senior escalation point for provider grievances, billing disputes, denials, and delays.
• Collaborate with Claims, Pre-Authorization, Fraud/Risk Management, and IT to streamline cashless processing and claim settlements.
• Lead and mentor Provider Relations Officers and Network Managers; ensure adherence to regulatory guidelines.

Job description

1. Network Expansion & Strategic Empanelment

• Identify geographic and specialized care gaps in the existing network to drive targeted provider empanelment.
• Evaluate, onboard, and empanel new hospitals, day-care centers, diagnostic chains, and specialized medical facilities based on quality, capacity, and geographical needs.
• Drive the end-to-end credentialing process, ensuring all network providers meet company standards, quality benchmarks, and accreditation criteria (e.g., NABH/JCI or local healthcare regulatory standards).

2. Tariff Negotiation & Cost Containment

• Lead high-stakes negotiations on tariffs, package rates, and fee schedules with provider management and hospital leadership to optimize cost efficiency.
• Establish favorable discount structures, volume rebates, and payment terms to drive claim cost-containment initiatives.
• Conduct periodic reviews and re-negotiations of existing contracts and MOUs upon renewal.

3. Provider Relationship Management & Governance

• Serve as the senior point of escalation for complex provider grievances, billing disputes, claim denials, and delayed payments.
• Conduct periodic performance reviews with key network hospitals regarding cashless turn-around-time (TAT), query resolution rates, and billing accuracy.
• Oversee regular audits and surprise facility visits to evaluate service quality, prevent fraud, waste, and abuse (FWA), and maintain network integrity.

4. Operational Integration & Claims Alignment

• Partner closely with internal Claims, Pre-Authorization, Fraud/Risk Management, and IT teams to streamline cashless request processing and claim settlement workflows.
• Ensure seamless data integration between hospital management systems (HMS) and TPA platforms to drive automation and reduce manual paper flow.
• Manage provider master data, ensuring directories, rate cards, and network status updates are accurate across consumer-facing platforms and portals.

5. Leadership & Regulatory Compliance

• Lead, mentor, and build high-performing Provider Relations Officers and Network Managers across target zones.
• Ensure strict adherence to insurance regulatory guidelines (e.g., IRDAI, CMS, state health laws, or delegated oversight mandates) regarding provider contracts and cashless administration.
• Oversee the continuous development and updating of the Provider Manual and onboarding documentation