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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 qualified individual for the following position will be based in Johannesburg Regional Office.
 
THIS IS AN INTERNAL AND EXTERNAL ADVERTISEMENT
 
SENIOR OFFICER: BILL REVIEWER T.A.S.K GRADE 12
SOBR09042021JHB
LOCATION: Johannesburg
CLOSING DATE & TIME: 4/20/2021 11:55 PM
 
Purpose of the Job: is to 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, CD16/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 services 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 services level agreement.
  • Ensure that services and treatments claimed for are accident related/ (related to the accident under consideration.
  • Reduces future health care cost and improve efficiencies by analysing trends in patients/injured persons use of services.
  • Compare outcomes and cost of efficient therapeutic modalities and surgical techniques and information provided is invaluable in developing guidelines for clinical management.
  • Manage future health care cost and improve efficiencies by analysing trends in utilization services.
  • Formal assessment of medical necessity and appropriateness of procedures that will be effective in curbing fraud and over serving by practitioners in the medical field alternatively curbing unreasonable demand for benefits from victims of road accidents.

 
Provide Human Resources 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 Researches
  • Integration of skills to non-medical assistants who will be doing bill review and 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.
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Qualifications and Experience:
  • NQF 6 (Diploma or Advance Certificate) in Nursing or Allied Health Professions or related qualification to discipline.
  • NQF 7 (Bachelor's Degree or Advance Diploma) in nursing/ Allied Health Professions related qualification to discipline will be an added advantage.
  • Registration with the relevant Health professional council.
  • Relevant 4 years' experience of which 1 year is on supervisory level.
  • Experience in Medical Billing, tariffs and coding.
 
Technical and behavioural competencies required:
  • Organisational Resilience
  • Team Resilience
  • Network and Alliances
  • Personal mastery
  • Judgment and Decision making
  • Emotional wisdom
  • Ethics and governance
  • Customer orientation and Customer Focus  
  • Knowledge of tariffs: National Health: References Price List (NHRPL) and Uniform Patient Fee Schedule (UPFS).
  • Knowledge of procedure and treatment codes: ICD 10 and CPT 4.
  • 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: 20 April 2021
 
Applications can be forwarded for attention of the recruitment officer at Johannesburg; e-mail address is Jhbrecruitment3@raf.co.za  or Hand delivered at 8-10 Junction Avenue, Block A, Parktown, Johannesburg.
 
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 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.