The holistic management of medical practices’ outstanding COIDA books combined with the management of collections for these books from the CF.
Key Performance Areas:
1. Medical Accounts Assessment
1.1. Process all the medical accounts for any batches received from the medical practice(s) allocated to employee for management of COIDA books.
1.2. Ensure that the claim related documentation complies with the rules governing claim acceptance as stipulated by the COID Act.
1.3. Ensure that the account and the invoiced tariffs comply with all requirements as per the COID Act and the annual Government Gazettes.
1.4. Ensure that the medical documentation supplied complies with the requirements for the specific discipline.
1.5. Ensure that the company’s database accurately reflects all the necessary data from the documentation received and that the batch is processed accurately and timeously.
1.6. Ensure that all accounts received by CompSol via eCOIDA or the Relay Standalone are processed timeously.
1.7. Ensure that queries are followed up with each batch or at least once a month.
1.8. Consult with your supervisor if you are not sure about certain elements regarding the claim.
1.9. Ensure that you are aware of the rules and guidelines provided by each new Government Gazette published by the CF.
1.10. Research medical terminology on the internet to ensure that the accounts and claims are assessed correctly.
1.11. Ensure that you are aware of the rules and guidelines provided by the Company in your training manual.
1.12. Ensure that constant contact is maintained with the practice regarding outstanding queries.
1.13. Instruct CSOs to assist with outstanding queries for practices where the number of queries is substantial.
2. Client Liaison
2.1. Ensure that the query lists reach your clients timeously before the deadline for payment of batches.
2.2. Ensure that communication with clients is clear, detailed and professional.
2.3. Ensure that you provide the necessary training to your practices with regards to any trends you identify with their queries.
2.4. Establish and maintain good client relationships ensuring that your contact is in line with the company objective to provide spectacular customer service at all times.
3. General Administration
3.1. Ensure that an age analysis is run for each of your practices every 3 months.
3.2. Ensure that the outstanding MRI, Prosthesis and claim re-opening approvals are followed up regularly.
4. Credit Control duties with the purpose of lowering the team’s average debtors’ days
4.1. The purpose is to ensure that the team’s average debtors’ days is the minimum possible for the teams’ medical practices.
4.2. Monitor the outstanding debtor’s book for each of your practices – ensuring the claims are timeously accepted and submitted to the CF for processing. (Submission of accepted claims include any accounts electronically submitted via IT to CF)
4.3. Ensure that your medical practices’ outstanding registration and not accepted accounts are registered (including completion of medical documents for adjudication) timeously for adjudication.
4.4. Endeavour to meet your collection targets with the team incentive.
4.5. Ensure that the weekly CF payment is allocated timeously and that the un-reconciled short payment list for your practices is maintained on a weekly basis.
4.6. Ensure that any unallocated payments received are resolved within 1 month from date of payment.
4.7. Ensure that accounts in credit is maintained and resolved within 1 month from date of payment.
4.8. Older than 18/24 month accounts – must be maintained on a regular basis and must ensure that all repudiated and cancelled claims are reversed timeously.
4.9. Ensure that any admin payments received are allocated within 10 working days from date of payment.
4.10. Follow up CF feedback, including internally blocked/rejected accounts, and ensure that the necessary actions are taken to resolve the feedback.
4.11. Ensure that your exempted IOD book is followed up on a regular basis to ensure that prompt payment is made by the exempted payor.
5. Special projects
5.1. Complete any special projects on instruction from Supervisor and/or Management.
1. Ability to work in a team
2. Ability to accurately capture & process large volumes of paperwork
3. Deadline driven individual able to perform under high pressure
4. Flexible to adapt to changes in daily routine on short notice
5. Excellent telephonic communication skills
6. Ability to establish and maintain good client relationships
7. Fluent in English. Afrikaans will be beneficial
8. Must have matric certificate or equivalent qualification
9. Aptitude for numbers/accounting – preferably debtors or creditors experience
10. Must be computer literate – intermediate knowledge of Word and Excel
11. Experience in medical practice administration is advantageous
1. Applicants are required to have:
a. No active disciplinary warnings; and
b. Must have relevant internal experience as Team Assistant, CF Claim Controller, Risk Claim Controller or Employer AA for a minimum of 12 months: o r
c. a Minimum of 2 years’ experience gained in employment outside of Compsol with debtors or creditors (experience in medical accounts will be advantageous);
2. Must obtain a minimum of 60% in the relevant skills assessments.