We are looking for a Medical Bureau Operations Specialist to join a big, leaading, tech company in the healthcare space. The position is niche and requires someone with Operations, Claims Administration and even some IT skills.
The Operations and Retention Manager plays a pivotal role in leading and expanding the claims administration team within the business. This position goes beyond traditional managerial responsibilities by actively contributing to the overall success of the bureau business. This specifically involves:
- Defining and executing the direction and vision for the claims administration department in accordance with the overarching strategy of the Bureau
- Leading, hiring, mentoring, and inspiring the claims administration team to achieve
- Fostering a positive work environment emphasising collaboration, innovation, continuous improvement and accountability
- Accountable for maintaining budgeted client churn levels (reduce churn and implement preventative measures).
- Driving the digitization goals of the business to leverage the development and data teams by collaborating with the relevant stakeholders
Duties:
- Establish, refine, and evaluate measurable Key Result Areas (KRAs) for Claims administrators and the supervisor, aligning them with organisational objectives
- Take ownership of the accountability process by implementing specific metrics (SOP’s), conducting regular reviews, and assessing individual performance
- Implement clear and measurable communication metrics to assess the quality and timeliness of interactions with clients on all channels.
- Ensure that reports sent to clients are adhered to the highest standards of quality and accuracy
- Maintain client churn rates below budgeted figures, implementing proactive strategies
- Be accountable for accurate tracking and analysis of churn metrics, and actively address and resolve issues to ensure high levels of client satisfaction
- Strategically lead the hiring process to build a dynamic and high-performing claims administration team, ensuring alignment with growth objectives.
- Identify and attract top talent
- Delivering and ensuring that the unique value proposition sold to a client is continuously met
- Instilling a culture of embracing automation within the team and acting as the driving force behind the adoption of digitisation and automation
- Working closely with the Tech team by fostering effective and clear communication and collaboration.
- Articulating and understanding the complex problems related to automation
- Testing and validation of newly built automation as well as integrating newly built automation into existing workflows while minimising disruptions
- Overseeing the billing and invoicing processes with the finance team while managing credit notes ensuring accurate financial transactions
- Collaborating with the line managers and business line executive to deliver on strategy
Qualifications & Experience
- Tertiary education in an associated field
- 3 years experience in a similar medical administrative management role in a business-to-business (B2B) context, within the healthcare sector
- 5 years of extensive coding experience in the medical billing industry, showcasing a comprehensive understanding of coding practices and industry standards.
- Experience in effectively managing and leading alarge team, demonstrating strong leadership skills, fostering a positive team culture, and achieving organisational objectives
- A proven track record of navigating and optimising financial processes, with a keen eye for detail and compliance with financial standards and regulations.
- Proven collaboration with technology/software teams, clear problem articulation, and adeptness in testing and integrating software solutions and new features into existing workflows.
- Extensive experience working at a master level on at least 3 PMA’s (Practice Management Applications)
- Demonstrate a versatile and comprehensive understanding of various systems.
- Proficient in Ms Excel, Word, Powerpoint or the Google Workspace alternative
- Curious about leading-edge technologies (e.g. AI, machine learning, LLMs)
- A keen focus on task efficiency, coupled with a mindset geared towards consistently measuring and reducing task completion times.
- Developing standard operating procedures
- Target setting and monitoring
- Management reporting
Knowledge and Skills
- In-depth knowledge of the medical services claims industry
- Excellent understanding of the application of rules and modifiers per discipline, alongside expertise in the legislation regulating the discipline.
- Expertise in ICD-10 coding
- Understanding of SAMA (South African Medical Association) and CMS (Centers for Medicare & Medicaid Services) rules
- Medical background, showcasing proficiency in medical terminology and a comprehensive understanding of human anatomy.
- Understanding of the processes, procedures, and systems used in the execution of credit control, with a focus on maximising clients’ cash flow and minimising bad debt.
- Excellent communication and people skills (verbal and written)
- Strategic and forward-thinking mindset
- Strong leadership abilities with the capacity to inspire, motivate and empower teams, both face to face and remotely
- Exceptional interpersonal and relationship-building skills
- Collaborative and team-oriented approach
- Can hold own ground during tough negotiations with different types of stakeholders, while remaining respectful, calm and mindful
- Excellent problem-solving and decision-making abilities
- Results-oriented
- Effective time management and organisational skills
- Adaptability and resilience
- Ethical and professional conduct with a commitment to integrity and confidentiality
- Dependable and diligent, consistently demonstrating trustworthiness and a strong work ethic.
NOTE – We ONLY accept online applications. We do not consider direct applications via Whatsapp or email.
SALARY DISCLAIMER: The advertised salary range is merely a guideline to attract a range of potentially suitable candidates to the advertised position. It is the prerogative of the future employer to offer a candidate any market related remuneration package in line with the candidate’s qualifications, skills and level of experience.
Desired Skills:
- bureau
- medical claims
- bureau operations
- medical bureau management