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ROAD ACCIDENT FUND (RAF)
 
The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads
 
The Organization requires the services of qualified individuals for the following position of Officer Bill Review on a Twenty-Four (24) Months Fixed Term Contract, the position will be based in their Cape Town Regional Office.
 
THIS IS AN INTERNAL AND EXTERNAL ADVERTISEMENT
 
OFFICER BILL REVIEW T.A.S.K GRADE 10
OBR09042021CPT
LOCATION: Cape Town
CLOSING DATE & TIME: 4/20/2021 11:55 PM
 
Purpose of the Job: Review Medical Bills. 
 
 
Key Performance Areas
Audit & review medical bills
  • Analysis of claimed items/services in correlation with available tariff structures and ICD 10 /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 cost and improve efficiencies by analysing trends in injured person's use of services
  • Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided
  • Manage future healthcare costs and improve efficiencies by analysing 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 Stake Holders.
  • Check and advise on tariffs used on accounts
  • Provided training on new developments
     
Approve medical expenses in accordance with relevant DOA.
  • Authorisation 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 dept and other key external stake holders.

Check & approve Payments in terms of DOA.
  • Receive invoices and check payment request for accuracy and correctness. 

Determine the level of care based on functional ability.
  • Analysis of medical data available eg. Case Manager's Reports, Clinical Records and Medico – Legal Reports

Pre authorization of procedures.
  • Analyse medical data to determine the need for the service
  • Timeous assessment of urgent files e.g. Road Shows

 
Qualifications and 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/ Allied Health Professions related qualification to discipline will be an added advantage.
  • Registration with the relevant Health professions council.
  • Relevant 3 years' experience in a medical field.
 
Technical and behavioural competencies required:
  • Personal mastery
  • Emotional wisdom
  • Ethics and governance
  • Customer orientation and customer focus
  • Computer literacy
  • Ability to interpret the rules of the UPFS tariffs
  • analytical skills
  • Organisational & administrative skills
  • Planning and Organising
  • Decision making
  • Negotiation skills
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Remuneration:
Total cost to company of the minimum remuneration 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 a manner that will suit their needs"
 
Closing date: 20 April 2021
 
Applications can be forwarded to the Recruitment Officer at the RAF, Cape Town branch; e-mail address is CPTRecruitment@raf.co.za  OR hand delivered to 2nd Floor, Correspondence Department, 1 Thibault Square, Long Street, Cape Town.
 
.INSTRUCTIONS 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 maxim of 5 pages
  4. Please indicate your current salary and salary expectations 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 under represented in terms of our Employment Equity Plan
 
NB:
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualifications evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

NB:
  • The position is a Twelve (12) Months Fixed Term Contract