OFFICER BILL REVIEW

Full-time

OFFICER BILL REVIEW – T.A.S.K GRADE 10

OBR160721DBN

LOCATION: Durban
CLOSING DATE & TIME: 7/27/2021 11:55 PM

Purpose of the Job: Review Medical Bills.

Key Performance Areas

Audit and review medical bills

  • Analysis of claimed items/ services in correlation with available tariff structures and ICD10/ CPT 4 codes
  • Requesting motivation for unreasonable accounts
  • Line by line analysis of claim items /service. Matching those appropriate tariffs/ICD/ CPT codes
  • Flagging rejected items/ services
  • Recommendations to the department responsible for processing payments
  • Auditing medical claims and assisting in technical aspects of bill review
  • Ensure that accounts submitted to the Fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act
  • Assess and monitor claims to curb over servicing or abuse and fraudulent claims
  • Ensuring that the accounts are paid timeously according to the service level agreements
  • Ensure that the services and treatments claimed are accident related (related to the accident under consideration)
  • Reduce future healthcare costs and improve efficiencies by analyzing trends in injured persons use of service
  • Compare outcomes and costs of different therapeutic modalities and surgical techniques and the information provided
  • Manage future healthcare costs and improve efficiencies by analyzing trends in utilization of services
  • Formal assessment of medical necessity and appropriateness of procedures the will be effective in curbing fraud and over servicing unreasonable demand of benefits from victims of road accidents

Promote good working relations with Stakeholders

  • Check and advise on tariffs used on accounts
  • Provided training on new developments

Approve medical expenses in accordance with relevant DOA

  • Authorization in accordance with mandate
  • Inform service provider of payment decision

    Assisting in technical aspects of bill review

  • Develop and manage relationships with department of health services, government department and other key external stakeholders

Check and approve payments in terms of DOA

  • Receive invoices and check payments request for accuracy and correctness

Determine the level of care based on functional ability

  • Analysis of medical data available, e.g. Case Managers reports, Clinical Records and Medico – Legal Reports

Pre- authorization of procedures

  • Analyze medical data to determine the need for the service
  • Timeous assessment of urgent files e.g. Road Shows

Qualifications & Experience

  • NQF 6 (Diploma or Advanced Certificate) in Nursing or Allied Health Professions or related qualification to discipline
  • NQF 7 (Bachelor’s Degree or Advanced Diploma) in Nursing or Allied Health Professions related qualification to discipline will be added advantage
  • Registration with the relevant Health professions council
  • Relevant 3 years’ experience in the medical field

 Behavioral and Technical Competencies

  • Personal Mastery
  • Emotional Wisdom
  • Ethics and Governance
  • Customer Orientation and Customer focus
  • Computer Literacy
  • Ability to interpret the rules of the UPFS tariff
  • Analytical skills
  • Organizational and administrative skills
  • Planning and organizing
  • Decision making
  • Negotiation skills
     

Remuneration

At the cost to company of minimum package applicable to this position is R349 998.00 per annum and will be negotiable commensurate with experience.

NB: “RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in manner that will suit their needs”.

Closing date:  27 July 2021

Applications can be forwarded to the Recruitment Officer at DurbanRecruitment@raf.co.za  Kindly note no hand delivered applications will be accepted due to COVID19. 

INSTRUCTION TO PROSPECTIVE APPLICANTS

  1. Indicate the name and the reference number for the position you are applying for on the subject line
  2. Do not submit copies of qualifications and ID as these will be requested from shortlisted candidates on the interview date
  3. Submit a short CV with a maximum of 5 pages
  4. Please indicate your current salary and salary expectation if considered for the position.

     The Road Accident Fund subscribes to the principles of employment equity and preference will be given to groups who are underrepresented in terms of our Employment Equity Plan

Please note that the prospective employees will be subjected to security vetting

NB: Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful.

NB: Preference will be given to people living with disabilities

N.B: It is the applicant’s responsibility to have foreign qualifications evaluated by the South African Qualifications Authority (SAQA) and to provide proof for such evaluation