Role Purpose
- Daily analysis and monitoring of bureau reports
- Confirm all claims are flagged and queried correctly
- Continuously consult with clients and confirm that all claims are allocated timeously.
- Become our clients trusted business champions.
- Ensure regular client contact, to ensure the company and Dr relationships are maintained.
- Ensure we build a partnership with the client in that they see us as a business partner and not a service provider
- Ensure all patient claims are managed with care and professionalism.
Description
- Reconcile all remittances.
- Query outstanding claims
- Resubmit outstanding claims.
- Maintain a low age analysis if not zero.
- Follow up on short payments.
- Flag claims regularly with valid updates
- Keep constant communication open with the practice and the client.
- Submit query reports biweekly to clients.
- Build relationships with clients.
- Service delivery is of utmost importance.
- Clearing Ontime rejections.
- Selecting correct scheme agreements so the client posts the correct rates annually.
- Maintain the ERA database.
- Claims should be managed well so they do not go stale.
- Any discrepancy in rates must be escalated to your manager.
- Regular monitoring of the remittances to pick up rates issues.
- Regular monitoring of the stats reports to ascertain your progress.
- Always ask for assistance from your manager when you are unsure of anything or come across a query you do not know how to handle.
- Regular communication logs.
- Take initiative in resolving issues.
Qualifications & Experience
- Matric and relevant administrative qualification
- 2 – 3 years of experience within the health care field (non-negotiable)
Desired Skills:
- claims administration
- medical aid
- Account Reconciliation
- customer service
- Reports
Desired Work Experience:
- 2 to 5 years
Desired Qualification Level:
- Degree
About The Employer:
We exist to transform healthcare to enhance people’s lives. We creatively look for ways to make healthcare more affordable, accessible and effective for everyone. Our innovative solutions ensure that patients, healthcare providers and other role players in the healthcare ecosystem benefit by collaborating together.
We seek high performers with a positive, growth mindset who will thrive in a culture based on strong values, accountability, openness, collaboration and no politics.