Manager - Medical Invoice Approval - Parktown at Rand Mutual - RMA

THE JOB AT A GLANCE

• The Manager - Medical Invoice Approval will be responsible for medical service provider relationships and establish network of service providers for optimal service delivery and liaison with medical service providers.

WHAT WILL YOU DO?

• Oversee the effective and efficient management of the Medical Benefit Department of the RMA with timeous capture and processing of medical invoices to ensure that medical accounts are paid promptly and correctly.
• Educate and training of Medical Service Providers (MSP) regarding RMA policies and requirements in respect of invoice submission.
• Establish database of medical service provider group and professional associations
• Identify and establish potential provider networks
• Management of key accounts and provider queries
• Ensure medical creditors are paid within reasonable time where all claim requirements are met.
• Ensure clear display and communication of payment details, rejections and reasons for non-payment
• Analysis of medical spend and provider usage patterns
• Negotiate and agree annually mutually acceptable tariff structures and discounts with Medical Service Providers or groups.
• Regular communication to MSP and provider network sharing RMA information and industry trends
• Encourage the use of the RMA MSP portal by service provider administrative staff
• Assist Medical Benefits Staff with understanding medical service appropriateness.
• Address risk management and mitigating actions appropriately
• Identify gaps and shortfall of subordinates on performance and agree on personal development plan

Requirements

WHAT YOU'LL BRING TO THE TABLE?

• Relevant Insurance / Medical (Nursing) Diploma or Degree
• 2 – 3 years’ relevant industry experience
• Medical background - nursing / medical scheme
• Understanding medical invoice aspects
• Client liaison