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ROAD ACCIDENT FUND (RAF) - OFFICER: BILL REVIEW X 2-PRETORIA
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 individuals within its Pretoria Regional Office for the following position:-
THIS IS AN INTERNAL AND EXTERNAL ADVERTISEMENT
OFFICER: BILL REVIEW X 2-PRETORIA
OBR-18112021-PTA
LOCATION: Pretoria
CLOSING DATE & TIME: 11/30/2021 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 ICD10 / CPT4 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 costs of different therapeutic modalities and surgical techniques and the information provided.
- Manage future healthcare costs and improved efficiencies by analyzing trends in utilization of services
- Formal assessment of medical necessity and appropriateness of procedures that 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.
- Provide training on new developments.
- Authorisation in accordance with mandate.
- Inform service provider of payment decision
- Develop and manage relationships with department of health services, government department and other key external stakeholders.
- Receive invoices and check payment request for accuracy and correctness.
- Analysis of medical data available e.g., Case Manager's Reports, Clinical Records and Medico–Legal Reports.
- Analyse medical data to determine the need for the service
- Timeous assessment of urgent files.
- NQF 6 Diploma (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.
- Compute Literacy.
- Ability to interpret the rules of the UPFS tariffs.
- Analytical Skills.
- Organisational and Administrative Skills.
- Planning and Organising.
- Decision making.
- Negotiation Skills.
- Personal Mastery.
- Emotional Wisdom.
- Ethics and Governance.
- Customer orientation and customer focus
- Integrity,
- Compassion,
- Accountability,
- Respect,
- Excellence
Remuneration
Total cost to company applicable to this position is minimum R349 998,00 per annum, negotiable.
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: 30 November 2021
Applications can be forwarded to the Recruitment Officer at Eco Glades; email address is Tsholanang.recruitment@raf.co.za
INSTRUCTION TO PROSPECTIVE APPLICANTS
- Indicate the name and the reference number for the position you are applying for on the subject line
- Do not submit copies of qualifications and ID as these will be requested from shortlisted candidates on the interview date
- Submit a short CV with a maximum of 5 pages
- Please indicate your current salary and salary expectations if considered for the position.
NB:
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
- 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 qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.