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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 Organisation requires the services of a qualified individual at its Pretoria Regional Office for the position:
 
THIS IS AN INTERNAL AND EXTERNAL ADVERTISEMENT
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SENIOR OFFICER BILL REVIEW TASK GRADE 12
SOBR12032021PTA
LOCATION: Pretoria
CLOSING DATE & TIME: 3/23/2021 11:55 PM
 
Purpose of the Role: Assess and Review Medical Bills.
 
 
Key Performance Areas
Assess and Review Medical Bills
  • Line by line analysis of claim items/services, matching them with appropriate RAF tariffs, CD10/CPT4 codes.
  • Flagging rejected items/services by using in-house rejection codes.
  • Final 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 service level agreements.
  • Ensure that services and treatments claimed for are accident related/ (related to the accident under consideration).
  • Reduce future health care cost and improve efficiencies by analyzing trends in patients/ injured persons use of services.
  • Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.
  • Manage future health care cost and improve efficiencies by analyzing trends in utilization services.
  • Formal assessment of medical necessity and appropriateness of procedures that will be effective in curbing fraud and over servicing by practitioners in the medical field alternatively curbing unreasonable demand for benefits from victims of road accidents.

 
Provide Human Resource Management
  • Plan, prioritize and allocate work to subordinates.
  • Quality control of subordinate's work.
  • Identify training needs jointly with subordinates.
  • Provide advice and on-job training where necessary.
  • Train and manage performance of subordinates.
  • Development of Policies, procedures and guidelines for the Medical Department.
  • Conduct Research.
  • Integration of skills to non-medical personnel.
  • Supervision of medical assistants who will be doing bill review on smaller claims.
      
Process payment Request
  • Recommend amount to be paid and provide reasons for rejection to the claimant or service provider.

Serious Injury Assessment
  • Review RAF Form 4's and other medico-legal reports.
  • Assist with determination of serious injuries.
  • Give an opinion on general damages  
 
 
Qualifications & Experience
  • NQF 6 (National 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 qualifications discipline will be an added advantage.
  • Registration with the relevant Health Professions Council.
  • Relevant 4 years' working experience of which 1 year is on supervisory level.
  • Experience in Medical Billing, tariffs and coding.  
 
Technical and Behavioral Competencies
  • Organisational Resilience
  • Team Resilience
  • Network and Alliances
  • Personal Mastery
  • Judgement and Decision Making
Emotional Wisdom
  • Ethics and Governance
  • Customer orientation and Customer Focus
  • Knowledge of tariffs: National Health Reference Price List (NHRPL) and Uniform Patient Fee Schedule (UPFS).
  • Knowledge of procedure and treatment codes: ICD 10 and CPT4.
  • Basic understanding of managed health care industry in South Africa. (Medical claims and charges)
  • Supervisory skills
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Remuneration
Total cost to company of the minimum remuneration package applicable to this position is R502,953 .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: 23 March 2021

Applications can be forwarded for attention of the recruitment officer at Menlyn; e-mail address is givenm.recruitment@raf.co.za  or hand deliver at 38 Ida Street, Menlo Park
 
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 underrepresented 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.