THE JOB AT A GLANCE
As a UX System Analyst, you will be responsible for the effective and accurate maintenance of tariffs and any other agreed upon tariffs such as ICD10 codes and treatment baskets. You will also be responsible for creating and executing test plans to ensure functionality and performance of relevant systems.
WHAT WILL YOU DO?
Project support
- Arrange Provide project support to the medical department.
- Provide support on and implement agreed additional projects, by project(s) plan date
ICD 10 code maintenance
- Responsible for the adjudication and maintenance of tariff codes and any other agreed tariffs, including ICD10 codes and treatment baskets
- Conduct and maintain crosswalks (ensuring that codes are linked correctly to each other) and confirm checks with the Medical Operations Manager
- Responsible for loading new ICD 10 codes on an ongoing basis. Submit to the GM: Medical and Claims Management for approval.
- Load and update RPL and CPT codes, based on new files, on an annual basis.
- Calculate payments and submit for approval.
- Liaise with IT to correct incorrect payments or payments that are not pulling through on the system.
- Create scenarios to test payments and formulas before going live.
- Monitor batches.
Stakeholder relationship management
- Provide advice and guidance to the medical invoice approval team around the relevance of codes.
- Providing support and feedback to Medical team.
- Provide interdepartmental support across Operations departments in scope
- Provide support to Pensions and Claims on annual renewals.
Query resolution and systems testing
- Obtain call logs from IT and investigate queries by testing defects and ensuring that the error has been resolved.
- Provide sign off to IT on resolved queries.
- Document findings and engage with IT if the query is beyond a user issue by assigning to developer where applicable
- Escalate complex queries to the Team Leader for resolution.
- Accurately test all development tasks on different environments in accordance with business requirements and technical specifications. Communicate with it to review defects until resolution.
- Design and execute test cases. Identify system inefficiencies and make recommendations.
- Record and document results and compare to expected results
- Document anomalies and issue
- Provide application instructions for users
- Create queries, scripts and other deliverables
General support
- Healthcare provider visits
- Ensure that the Medical Service Provider information on the system complies with the BHF, HPCSA and other practitioner registration bodies.
Reporting, risk, and compliance
- Use appropriate templates and channels to report on progress on a weekly and monthly basis, in line with the QA Framework and Governance structures agreed
- Adhere to deadlines and ensure accuracy and quality
- Support the design and Implementation of Agreed Management Actions as recorded in Audit reports published during the measuring period by due date as recorded in the final audit report excluding due date extensions.
- Ensure that risk management actions for identified risks are appropriately addressed.
- Comply with high-risk items on the RMA regulatory report.
WHAT YOU’LL BRING TO THE TABLE?
- NQF Level 7: Medical Degree in Nursing, Healthcare or related
- Certification in systems testing
- At least 5 years job experience, 2 of which should have been in a medical invoice processing and adjudication environment
- Computer literacy – MS Office
- Worked in a multi-project environment
- End-to-end testing applying various testing techniques
- Relevant knowledge of testing methodologies will be advantageous
- Proficient understanding of medical industry billing guides/gazettes for doctors and hospital accounts
- Proficient understanding of COID, NRPL, SAMA and other tariff structures including modifier application
- Proficient understanding of ICD10Code application
WHAT WILL YOU GET IN RETURN?
We offer great opportunities for personal and professional development in a stable company that’s 127 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.
Turnaround time
The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers. Kindly note that should you not receive a response within 21 days please consider your application unsuccessful.
Closing date: 1 Decemebr 2022
Our Commitment to transformation:
In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups.
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About The Employer:
- NQF Level 7: Medical Degree in Nursing, Healthcare or related
- Certification in systems testing
- At least 5 years job experience, 2 of which should have been in a medical invoice processing and adjudication environment
- Computer literacy – MS Office
- Worked in a multi-project environment
- End-to-end testing applying various testing techniques
- Relevant knowledge of testing methodologies will be advantageous
- Proficient understanding of medical industry billing guides/gazettes for doctors and hospital accounts
- Proficient understanding of COID, NRPL, SAMA and other tariff structures including modifier application
- Proficient understanding of ICD10Code application