Medical Credit Controller

at  Qetello Holdings

Together with our client, a leading claims administrator in Johannesburg North, we are recruiting for a Medical Credit Controller to assist with Private and medical aid claims.

QUALIFICATIONS AND EXPERIENCE:

• Matric / Grade 12
• Credit Control/debt collection within a medical bureau, performing collections on specialist doctors patient accounts
• CPT 4 Code experience
• Tariff code experience
• ICD 10 Coding experience
• Valid driver’s license and own vehicle

SKILLS AND COMPETENCIES:

• Computer literate in MS Office (Microsoft Excel, Word, and PowerPoint; and Outlook)
• Articulate with strong communication skills (oral and written)
• Ability to adapt and learn new skills.
• Ability to multitask.
• Cope well under pressure.

• Implement credit control procedures for specialist doctors and Allied Professionals in accordance with our credit control/debt collection policy
• Experience in collecting payments for specialist patient accounts with medical aids, with proficiency in at least four of the following specialties: Surgery, Gynaecology, Paediatrics, Urology, Physiotherapy, General Practice (GP), Physician and Psychiatry.
• Follow up with medical aids to ensure prompt payment of outstanding claims.
• Apply any necessary fixes or adjustments to claims.
• Monitor and follow up on claims related to Prescribed Minimum Benefits (PMB), providing relevant documentation as required.
• Collect payments directly from patients for accounts where they are liable.
• Perform daily reconciliation of Electronic Remittance Advice (ERA) and bank statements.
• Obtain and input manual Remittance Advices (RA)
• Resolve rejections from medical aids and upfront claim rejections
• Submit paper claims when electronic submission is not possible
• Provide timely responses to inquiries from both medical practices and patients
• Follow the handover process once the collection process is completed
• Perform any additional duties as requested by supervisors and management