Technical Specialist: Tariff Management at Momentum Metropolitan Holdings Limited

About the job

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations.

We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities and businesses. Visit us at www.momentummetropolitan.co.za #HLTH

INTRODUCTION

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings Limited, delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximize lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.

ROLE PURPOSE

To manage the accuracy and quality of data in the Provider Tariff Master Files. The incumbent works in close collaboration with the Tariff Modelling and Rate Negotiation function and is responsible for the accuracy and efficiency of tariff file loads and for the maintenance of data quality across tariff files. The incumbent will also work with the Claims Management and Provider Management teams to resolve any tariff discrepancies and to ensure the integrity of claims adjudication processes.

What You're Going To Do

• Work with the tariff modelling and clinical teams to analyse the impact of new tariff proposals

• Work with the provider reimbursement negotiation team to analyse the impact of tariffs and rates over the year

• Work with the provider reimbursement negotiation team in annual tariff negotiation processes

• Work with the provider reimbursement negotiation team to prepare tariff files for loading, with the IT Teams in file loads and for checking the accuracy of the tariff file load against rate agreements

• Work with provider engagement team to prepare tariff related communications

• Manage all discrepancies in loaded tariffs and resolution of related tariff file queries

• Work with business and IT Teams to specify system requirements related to reimbursement models

• Prepare and maintain operational documents and reports that relate to tariff file management

• Identify opportunities to enhance cost effectiveness and increase operational efficiency

• Positively influence and participate in change initiatives

• Participate and contribute to a culture which builds rewarding relationships and provides exceptional service

• Continuously develop own expertise in terms of professional and industry and legislation knowledge

• Manage financial and other company resources under your control with due respect

• Act as ambassadors for the company in all external interactions

• Take ownership for driving career development.

What You'll Need

• 4-5 years’ experience in the Medical Administration and/or Managed Care Industry

• Sound knowledge of clinical coding structures especially tariff schemas

• Understanding of medical scheme legislation including Council for Medical Schemes and Board of Healthcare Funders functions

• Proficiency with Microsoft Office Suite particularly Excel

• Experience with the Oracle operating system advantageous

• Tertiary qualification in medical field an advantage.

What Competencies You'll Require

• Technical mindset

• Knowledge of clinical coding – ICD-10, CPT-4, RPL Tariffs, NAPPI etc.

• Understanding of tariff structures and claims management processes

• Able to work under pressure, meet deadlines and drive for results

• Solutions orientated

• Self-awareness

• Diversity and inclusiveness.

Additional Information

Shortlisted candidates will be subject to the following statutory checks

• References

• Criminal

• Credit

• Qualifications

DISCLAIMER

• Only on-line applications submitted via our careers page will be considered.

• Internal Team Members must inform their manager of their application. Your manager must be aware of and support your application.