Billing Operations Cluster BOC File Assessor

Netcare Pharmacies; Pretoria; On-site; ZAR 240,000 - 360,000; Full time

Job summary

Netcare invites you to be part of our journey as a BOC File Assessor responsible for reviewing and correcting patient accounts to ensure accurate billing in line with NTBG and collectable formats.

The role requires the ability to assess accommodation needs, theatre events, and services billed on accounts, with final checks performed electronically and adherence to policy. Strong attention to detail and knowledge of ARM agreements are essential.

Qualifications

• Grade 12 or equivalent NQF Level 4 qualification.
• Experience in a healthcare setting.
• Experience with any clinical or healthcare billing systems.

Responsibilities

• Review and assess patient accounts for accuracy and final billing.
• Verify accommodation level of care and length of stay for billing.
• Examine theatre events for time, type and equipment to ensure correct charges.
• Ensure services are billed per actual use (surgicals, ethicals, DBOs, gases).
• Identify SAP billing errors and interim billing issues on long‑term accounts.
• Utilize billing tools to reduce errors before final submission to funder.

Skills

Customer Focus and Service Delivery

Personal Work Ethic

Building Relationships

Communication

Teamwork

Technical Knowledge

Education

Grade 12 or equivalent NQF Level 4 Qualification

Job description

We provide meaningful careers that connect people with purpose.

We are united by a common purpose of providing the best and safest care; and by our shared values of Care, Truth, Participation, Compassion and Dignity.

Netcare invites you to be part of our journey.

ROLE SUMMARY

The BOC File Assessor will be responsible for reviewing and correcting all aspects of the patient account. The incumbent must ensure that the final billed account is accurate, in accordance with the Netcare Tariffs & Billing Guidelines (NTBG) and in a collectable format.

KEY WORK OUTPUT AND ACCOUNTABILITIES

DISRUPTIVE INNOVATION

• File assessing
• Assessing of actual accommodation, level of care and length of stay of patients.
• Assessing of theatre events for time, theatre type and equipment.
• Assessment of services to ensure that all surgicals, ethicals, direct buy outs (DBOs), gases are billed on account as per actual use.
• Assessing of long‑term patient accounts for interim billing to identify SAP billing error messages.
• All final assessing needs to happen electronically on the provided systems.
• Following up on DNYB delay reasons.
• Utilization of billing tools (BOS, Billing Estimation, Billing Mapping etc.) to decrease errors before submitting a final billed account to the funder.
• Apply knowledge of ARM agreements to reduce billings errors. Be vigilant how the rules are applied by the system.

General – Any other duties assigned by the Billings Manager from time to time.

E-queries

Study rejection trends and proactively apply knowledge to prevent short payments and rejections.

Final gatekeeper

Limit reputational risk due to under- or over billing . File assessor as final gatekeepers on the quality of our accounts must exercise judgement to prevent premature final billing of inaccurate accounts.

TRANSFORMATION OF OUR SOCIETY

Personal and professional development

Assume responsibility for own personal and professional development, including completion of Insight Training.

Keep up to date with Netcare's evolving policies and procedures.

SKILLS PROFILE

EDUCATION

Required: Grade 12 or equivalent NQF Level 4 Qualification

WORK EXPERIENCE

• Required: Experience in a healthcare setting.
• Experience with any clinical or healthcare related billing systems.

KNOWLEDGE

Required: Computer literate

PHYSICAL REQUIREMENTS

In the event of any physical or psychological limitation that may impair the employee's ability to perform the required job function, the employee must consult the employer for reasonable accommodation.

SKILLS

• Customer Focus and Service Delivery – The capacity to identify and respond to the needs of *internal and external customers.
• Personal Work Ethic – Capacity to instil an ethic of quality and consistency in self and others.
• Building Relationships – Capacity to establish constructive and effective relationships.
• Communication – The capacity to clearly present information, either written or verbal.
• Teamwork – Capacity to cooperate with others to work towards a common goal.
• Technical Knowledge – The capacity to perform a technical function to required standards.

WORKING CONDITIONS

Professional flexibility in working hours while supporting daily business operations which may include weekends and night shifts where applicable. Will interact with internal and external customers through several different means.

NETCARE VALUES AND BEHAVIOURS

Netcare Values

At Netcare, our core value is care. We care about the dignity of our patients and all members of the Netcare family. We care about the participation of our people and our partners in everything we do. We care about truth in all our actions. We are passionate about quality care and professional excellence.

At Netcare, our core value is care .

We care about the dignity of our patients and all members of the Netcare family.

We care about the participation of our people and our healthcare partners in everything that we do.

We care about the truth in all our actions.

We listen with empathy and respond with acts of compassion in all interactions with our patients and their families.

The Netcare Way

Netcare is committed to providing quality care. Our basic service standard holds us accountable for the below seven behaviours which you will be accountable to uphold:

Respect - I always greet everyone to show my respect.

Identity - I always wear my name badge to show my identity.

Dignity - I always treat others with consideration and humility to uphold dignity

Care - I always act in the best interest of Netcare and others to show I care

Compassion - I always listen with empathy and respond with kind action to show my compassion

Appreciation - I always say thank you to show my appreciation.

Diversity - I always embrace diversity to strengthen inclusivity and belonging.

Join the team committed to providing the best and safest health and care.