ROAD ACCIDENT FUND:BILL REVIEWER


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 individual on a Three (3) Year Fixed Term Contract for the following position; the position will be based in Head Office:-

THIS IS AN INTERNAL AND EXTERNAL ADVERTISEMENT

SPECIALIST: BILL REVIEWER: T.A.S.K GRAD 14

08082019SBR

LOCATION: CenturionCLOSING DATE & TIME: 2/25/2020 11:55 PM

Purpose of the Job: Reporting to the Medical Advisor, the successful incumbent will be accountable to review medical bills, to provide input to the development of treatment protocols in line with the scope of practice of Registered/ Professional Nurses. As part of the clinical research and treatment policy team, this role applies clinical knowledge to assess and ensure services/ items billed are reasonable and necessary as per applicable policies and procedures.

Key Performance Areas

  • Develop Bill Review rules and guidelines.
  • Audit and review medical bills.
  • Provide input into treatment protocols.
  • Provide support to Bill reviewers.
  • Stakeholder relations.

Qualifications and Experience

  • Bachelor’s Degree or Advanced Diploma @ NQF 7 qualification in Nursing or equivalent related.
  • Valid Registration with the SANC as a Registered Nurse.
  • Qualification in Critical care/ Emergency care/ Theatre technique will be advantageous.
  • Relevant 5 – 7 years’ experience in an ICU Unit/ High Care/ Emergency Unit of a multidisciplinary hospital or Medical Scheme environment of which 2 years must have been on a supervisory level or area of expertise.
  • With experience working with ICD 10 codes, CPT codes and NAPPI codes, tariffs and all modalities of treatment in ICU, theatre and ward.

Technical and behavioral competencies required

  • Strategic capability and leadership
  • Results orientation
  • Business and financial acumen
  • Brand and stakeholder orientation
  • Organisational resilience
  • Communication
  • Team resilience
  • Network and alliances
  • Talent management
  • Change managementAn understanding of the applicable rules to service providers with regards to their scope of practice and the maximum charge.
  • Ability to understand unit standards, per service provider and management of exceptions by treating doctors.
  • Working knowledge of medical claims, related charges and clinical audit claims.
  • Vast knowledge of MVA and related complications.
  • Knowledge and understanding of new technologies in the rehabilitation process.
  • Ability to work and create crosswalks for system development.

Remuneration

Total cost to company applicable to this position is minimum R668 907.00per annum, negotiable.

Closing date: 25 February 2020 

Applications can be forwarded to the Recruitment Officer at Eco Glades;email address isLamkwelwem.recruitment@raf.co.zaOR hand delivered at 420 Witch-Hazel Avenue, Eco Glades 2, Centurion.

INSTRUCTION TO PROSPECTIVE APPLICANTS

  1. Indicate the name and the reference number for the position you are applying for on the subject line
  2. Do not submit copies of qualifications and ID as these will be requested from shortlisted candidates on the interview date
  3. Submit a short CV with a maximum of  5 pages
  4. Please indicate your current salary and salary expectations if considered for the position.

     The Road Accident Fund subscribes to the principles of employment equity and preference will be given to groups who are underrepresented in terms of our Employment Equity Plan

Please note that the prospective employees will be subjected to security vetting

NB:Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

NB: It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation

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