Senior State Accountant: Finance (medical Aids/schemes)

PROVINCIAL ADMINISTRATION: WESTERN CAPE DEPARTMENT
DEPARTMENT OF AGRICULTURE
Directorate: Management Accounting (Revenue Administration)
SALARY : R281 418 per annum
CENTRE : Head Office, Cape Town
CLOSING DATE : 13 April 2018

REQUIREMENTS :
Minimum educational qualification: 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 experience with medical scheme claims at a medical scheme or administrator.
Extensive 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 frolicence.
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 tariff structures.
Knowledge of medical scheme governing bodies, e.
g.
BHF and CMS.
Effectively interpret mrespective schemes.
Computer literacy in Microsoft Office applications (Word, and Excel).

DUTIES :
Oversee submission of medical scheme claims, including interaction with the Departmschemes re the follow-up of unpaid medical scheme claims.
Provide support claims, legislative requirements and industry changes pertaining to medical schemes.
Compile departmental policy directives regarding medical scheme Receivable systems and third party systems.
Identify underlying reasons for short or non-payment of claims and resolve with medical schemes.
Perform Accounts Receivable systems.
Validation of Practice numbers (PCNS) with the Board of Healthcare Funders.
Represent the Department in engagements with internal and external clients.

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