Medical Billing Claims Administrator

Qetello; Pretoria; On-site; ZAR 180,000 - 260,000; Full time

Benefits offered by this job

Annual bonus

21 days leave

Exposure to specialist billing

Job summary

Qetello is seeking a Medical Billing Claims Administrator in Pretoria East to manage specialist client billing, submit claims, and resolve rejections from medical aids. You will apply ICD-10, CPT, and PMB modifiers while maintaining accurate records and professional client communications.

The role requires hands-on specialist billing experience, meticulous attention to detail, and the ability to work under pressure in a fast-paced environment. Competitive salary and leave benefits are offered.

Qualifications

• Matric / Grade 12 completed.
• At least 2 years of recent medical billing experience.
• Direct billing experience for Medical Specialists.
• Knowledge of ICD-10, CPT, PMBs and modifiers.
• Proficient with Excel, Outlook and billing systems.

Responsibilities

• Manage full billing cycles for specialist clients.
• Submit claims and resolve rejections and queries from medical aids.
• Apply ICD-10, CPT codes and procedures accurately.
• Handle PMB claims and apply modifiers correctly.
• Liaise with clients, practices, patients and schemes.
• Maintain up-to-date billing records.
• Support reconciliations and month-end processes.
• Ensure data accuracy and confidentiality.

Skills

Attention to detail

Communication skills

Client service

Analytical thinking

Education

Matric / Grade 12

Tools

MS Excel

Outlook

Billing systems

Job description

Medical Billing Claims Administrator

Location: Pretoria East

Salary: Market-related

Specialisation: Specialist Medical Billing (Private Practice & Bureau)

About the Opportunity

A well-established Medical Bureau based in Pretoria East is looking for a Medical Billing Claims Administrator with recent, hands-on experience in specialist billing. This role is ideal for someone who thrives in a fast-paced, detail-oriented environment and understands the intricacies of private specialist claims, medical aid protocols, and clinical coding.

Key Responsibilities

• Manage full billing cycles for specialist clients
• Submit claims and resolve rejections and queries from medical aids
• Apply ICD-10, CPT, and procedure codes accurately
• Handle PMB claims and apply modifiers correctly
• Liaise professionally with clients, practices, patients, and schemes
• Maintain up-to-date billing records
• Support reconciliations and month-end processes
• Ensure data accuracy, confidentiality, and service excellence

Minimum Requirements (All are essential)

• Matric / Grade 12
• Minimum 2 years of recent medical billing experience in a Medical Bureau or Specialist Practice
• Direct billing experience for Medical Specialists
• Working knowledge of:
  • ICD-10, CPT, and procedure coding
  • Medical scheme rules and billing procedures
  • PMBs and relevant modifiers
• Computer proficiency: MS Excel, Outlook, and billing systems
• Own reliable transport and valid driver’s license
• High attention to detail and data accuracy
• Able to work under pressure with minimal supervision
• Strong communication and client service skills

What the Client Offers

• Competitive monthly salary based on experience
• 21 days of annual leave
• Annual performance-based bonus
• Exposure to specialist-focused billing and claims
• Supportive, process-driven work environment