Road Accident Fund
.
The Road Accident Fund is a state insurer established by statute, it provides insurance cover to all drivers of motor vehicles in South Africa in respect of liability incurred or damage caused as a result of a traffic collision. Liability incurred in relation to property damage (such as damage to vehicles, buildings, vehicle contents) is excluded from cover.
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Officer: Bill Review
Job Type Contract
Qualification Bachelors , Higher National Certificate , National Certificate
Experience 3 years
Location Western Cape
City Cape Town
Job Field Administration / Secretarial  , Medical / Healthcare 
Key Performance Areas
Audit & review medical bills.
Analysis of claimed items/services in correlation with available tariff structures and ICD 10 /CPT 4 codes.
Requesting motivation for unreasonable accounts.
Line by line analysis of claim items/service. Matching those appropriate tariffs/ICD/CPT codes.
Flagging rejected items/services.
Recommendations to department responsible for processing payments.
Auditing medical claims and assisting in technical aspects of bill review.
Ensure that accounts submitted to the Fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
Assess and monitor claims to curb over servicing or abuse and fraudulent claims.
Ensuring that the accounts are paid timeously according to the service level agreements.
Ensure that the services and treatments claimed are accident related/ (related to the accident under consideration).
Reduce future healthcare cost and improve efficiencies by analysing trends in in injured person’s use of services.
Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided.
Manage future healthcare costs and improve efficiencies by analysing trends in utilization of services.
Formal assessment of medical necessity and appropriateness of procedures the will be in effective in curbing fraud and over servicing unreasonable demand of benefits from victims of road accidents.
Promote good working relations with Stake Holders.
Check and advise on the tariffs used on accounts.
Provided training on new developments.
Approve medical expenses in accordance with relevant DOA.
Authorisation in accordance with mandate.
Inform service provider of payment decision.
Assisting in technical aspects of bill review.
Develop and manage relationships with department of health services, government dept and other key external stake holders..
Check & approve Payments in terms of DOA.
Receive invoices and check payment request for accuracy and correctness.
Determine the level of care based on functional ability.
Analysis of medical data available e.g. Case Manager’s Reports, Clinical Records and Medico – Legal Reports.
Pre authorisation of procedures.
Analyse medical data to determine the need for the service.
Timeous assessment of urgent files e.g. Road Shows.
Qualifications
Bachelor’s Degree or Advanced Diploma in nursing/ Allied Health Professions or related qualification
Registration with the relevant Health professions council.
Experience
Relevant 3 years’ experience in a medical field.
Competencies
Behavioural:
Personal mastery
Emotional Wisdom.
Ethics and Governance.
Customer orientation and customer focus.
Method of Application
Interested and qualified? Go to Road Accident Fund on careers.raf.co.za to apply
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