PROVINCIAL ADMINISTRATION: WESTERN CAPE DEPARTMENT
DEPARTMENT OF HEALTH
Directorate: Management Accounting: Revenue Administration
SALARY : R281 418 per annum
CENTRE : Head Office: Cape Town
CLOSING DATE : 29 June 2018
Minimum educational qualifications: Senior Certificate (or equivalent) with Mathematics and/or Accounting as a passed subject and/or Senior Certificate (or equivalent) with extensive experience/competencies that focuses on the Key of the post.
Experience: Appropriate working experience with medical scheme claims at a medical scheme or administrator.
Appropriate experience and knowledge of scheme rules, legislation and claims management in the Medical Scheme industry.
Extensive public and private sector experience regarding the management of medical scheme claims.
Inherent requirements of the job: Willingness to travel on a regular basis away from work Competencies (knowledge/skills): Knowledge of operational and management aspects pertaining to the processing of claims within the medical scheme industry.
Knowledge of legislative governance relating to medical schemes.
Knowledge of the Hospital Fees policies and procedures.
Knowledge of public and/or private sector tarrif structures.
Knowledge of medical scheme governing bodies, e.
BHF systems and/or from the respective schemes.
Computer literacy in Microsoft Office applications (Word, and Excel).
Oversee submission of medical scheme claims, including interaction with the schemes re the follow-up of unpaid medical scheme claims.
Provide support and legislative requirements and industry changes pertaining to medical schemes.
Compile departmental policy directives regarding medical scheme claims.
Obtain and third party systems.
Identify underlying reasons for short or non-payment of claims and resolve with medical schemes.
Perform ongoing validation of medical of Practice numbers (PCNS) with the Board of Healthcare Funders.
Represent the Department in engagements with internal and external clients.
Ms L Ismail, Tel No: (021) 940-4553
APPLICATIONS : Applications are submitted online via www.westerncape.gov.za/health-jobs
NOTE : No payment of any kind is required when applying for this post.