The successful implementation of all scheme, provider and vendor (list is not exhaustive) related rules by the Data Admin Department
- Ensuring that the Implementations department tasks are completed within defined SLAs
- Ensuring that the Quality Assurance department tasks completed as per defined SLAs and SOPs focusing on Quality output
- Manage all the Quality Control department tasks with a focus on Claim file transfers, QC of NAPPI codes, ERA’s, Providers Statements, etc
- Manage the end to end Funder/ scheme reconciliation process in the Fund Control Department
- Evaluate and implement procedures and processes within Operations Implementations department with a focus on continuous improvement and automation
DUTIES AND RESPONSIBILITIES
- Operational Excellence
- Documentation
- Communication
- Project Management
- Staff Management and Development
- Departmental Analysis and Reporting
Desired Skills:
- – Grade 12/ Matric. – Tertiary education – B-Com
- Tertiary education – B-Com
- BPharm or BSc.
- Understanding of the current core processing system.
- Clinical experience would be advantageous.
- Familiarity with technology.
- . – Process Management experience
- Staff Management and Development experience
- 4 – 5 years related experience in medical schemes.
Desired Qualification Level:
- Degree
About The Employer:
Healthcare Company