Job Description:
The position of Practitioner Tariff and Billing Rules Manager is vacant. The Practitioner Tariff and Billing Rules Manager will report directly to the Senior Manager Tariff and Billing Rules and forms part of the Healthcare Management Division. The position is based at Head Office in Pretoria.
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Job Responsibilities:
Manage the implementation of the full and final settlement agreements with regards to matters relating to practitioner tariffs, clinical coding and ARMs.
Review and provide input for all managed care reports and comment on service levels regarding practitioner tariffs and clinical coding.
Submit and present a summary report on practitioner tariff management and clinical coding to
Senior Manager :Tariffs and Billing Rules.
Manage and monitor practitioner tariffs and clinical coding on a monthly and quarterly basis.
Manage the all GEMS Practitioner tariff file.
Conduct Practitioner Tariff Management and Alternative Reimbursement Models (ARM) Workshops.
Administration and support for the implementation of ARMs (i.e. Fixed Fees, Global Fees, Per Diem Fees, etc.).
Ensure timeous submission of all practitioner tariff, clinical coding and ARM reports from SPNs.
Produce a report on all engagements between the Division and healthcare service providers with regards to practitioner tariffs management and clinical coding.
Manage the GEMS Practitioner Billing Rules Manual.
Identify inefficiencies and propose remedial measures for matters relating to practitioner tariff management and clinical codingo Implement corrective measures for matters relating to practitioner tariff management and clinical coding.
Manage and evaluate service levels of the scheme's managed care service provider.
Job Requirements:
Managerial/Coaching/ Mentoring Skills.
Be responsible and reliable.
At least 6 years work experience in the healthcare funding/ medical Scheme industry.
A post graduate qualification will be advantageous
Presentation Skills.
Be organised and have good time management skills.
Have resilient pressure management skills.
Must be computer literate at advanced level.
Have strong negotiation skills.
Experience at Team leader or Manager level will be beneficial
Customer focus.
Have ability to work well as part of a team.
Self-motivated and pro-active.
Must have experience in the development and presentation of management reports.
Knowledge Management Skills.
Professional behaviour.
Must have an understanding of the medical aid industry.
Degree/National Diploma or equivalent NQF level 6 in Clinical Sciences (medical/ nursing/ physiotherapy/psychology etc.).
Be analytical and have ability to manage priorities.
Job Details:
Company: Government Employees Medical Scheme – GEMS
Vacancy Type:Full Time
Job Location: Pretoria
Application Deadline: N/A
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