Centurion: Tariff and Payment Arrangement Coordinator posted by AllSpes (Pty) Ltd

Job Title:
Tariff and Payment Arrangement Coordinator

Company:
MediCharge

Position Overview:
Collaborate closely with the Medical Scheme representatives to establish a clear understanding of all available Payment Arrangements and maintaining current working knowledge of Healthcare related issues, Scheme rules and regulations. Maintain accurate and detailed records of all documentation related to Payment Arrangement and provide training to MediCharge staff on new Payment Arrangement implementations or changes.

Maintain up to date knowledge of the accurate and efficient loading and maintenance of tariff files and Payment Arrangements within VeriClaim. This individual will share co-responsibility with the Tariff Coordinator for the year-end process, where tariffs for all Medical Schemes are updated for the new year within VeriClaim.

Essential Job Functions:

• Serve as the main point of contact for Payment Arrangement inquiries and communications related to Payment Arrangements.
• Build and maintain strong relationships with key Medical Schemes, SpesNet and any other relevant parties and facilitate transparent communication channels between VeriClaim and the Medical Schemes.
• Stay informed about any changes made by the Medical Schemes for example Payment Arrangements, fixed fees, provider specific agreements, how fixed fees influence Payment Arrangements etc.
• Take ownership of new Payment Arrangements or changes to Payment Arrangements to ensure that a full investigation is conducted, all information is obtained, clear understanding of how it works and a Change Request is compiled for the changes to be made on VeriClaim.
• Maintain up to date knowledge of how Payment Arrangements work on VeriClaim and conduct regular analysis to ensure that it is implemented correctly and suggest improvements to workflow, implementations and efficiencies.
• Maintain accurate and detailed records of any documentation related to Payment Arrangements and regularly update these records.
• Responsible for knowledge sharing ensuring all MediCharge staff know how Payment Arrangements work and how it is implemented on VeriClaim, this should be done through training, upskill sessions and providing guidance (including any necessary training material and reference guides) to all MediCharge staff.
• Maintain an updated and functional understanding of Scheme increases, Scheme rules, Conversion Factors, Payment Arrangements, VeriClaim Billing Engine, Tariff App, etc.
• Assist with obtaining tariff files and/or assist with general tariff related queries, Payment Arrangement information etc.
• Co-responsibility of managing and coordinating all tariff files/Payment Arrangements received (throughout the year and during year-end), which include but is not limited to:
  • Proper quality assurance on tariff files/Payment Arrangements received.
  • Review and accurately interpret tariff files/Payment Arrangements and rulings.
  • Loading of tariff files/Payment Arrangements accurately and timeously.
  • Responsible for calculating and updating of rand conversion factors.
  • Maintain and manage a report or control sheet which indicates when and why tariffs/Payment Arrangements were amended or updated on VeriClaim.
• Coordination of all tariff and Payment Arrangement related issues, queries and/or updates and provide support on resolution of queries from practices, internal staff and third parties.
• Ensure effective and insightful communication with Medical Schemes, which includes asking correct and pertinent questions, to obtain all answers required for optimal tariff query resolution.

Skills and Functional Requirements:

• Ability to build and maintain meaningful relationships.
• Ability to work under pressure and to multi-task.
• Analytical thinker.
• Detail orientated.
• Deadline focused.
• Excellent interpersonal skills.
• Excellent problem-solving skills.
• Excellent organisational skills.
• Excellent time management skills.
• Excellent conflict management skills.
• Knowledge of the VeriClaim system.
• Highly motivated and enthusiastic.
• Knowledge of Outlook and Word and expert knowledge of Excel.
• Self-confidence.
• Customer focused & ability to build customer relations.
• Bilingual: spoken and written language.
• Excellent Communication skills: Written and verbal.

  NOTE: This role specification is not intended to be all-inclusive. The employee may perform other related duties to meet the ongoing needs of the organisation.