Medical Practice Manager (billing experience), Midstream – REF#IMR060-PM

iMedrecruit; Centurion; On-site; ZAR 480,000 - 720,000; Full time

Job summary

iMedrecruit is seeking an experienced Practice Manager to oversee the day-to-day operations of a high-acuity orthopaedic trauma and reconstructive surgery practice in Gauteng. You will lead administrative and billing staff, ensure PMB submissions and COID claims are accurate, timely and compliant, and manage revenue-cycle processes.

The role requires strong leadership, ICD-10 coding proficiency, and familiarity with PMB regulations.

Qualifications

• Private specialist medical practice experience
• PMB and COID experience essential
• Experience with high-volume COID/iod claims
• Strong ICD-10 coding knowledge and billing proficiency
• Leadership experience managing administrative staff
• POPIA compliance knowledge
• Financial oversight and budgeting experience
• Experience liaising with funders and hospitals
• Ability to train staff on trauma coding and PMB rules
• Capability to manage quality of service and revenue cycle

Responsibilities

• Oversee day-to-day operations of the practice to ensure smooth patient flow and service delivery.
• Lead, mentor and support administrative and billing staff.
• Ensure adherence to policies, procedures, and healthcare regulations.
• Manage staff leave and drive accountability and continuous improvement.
• Train billing and admin staff on trauma ICD-10 coding, PMB regulations, and COIDA requirements.
• Maintain PMB and COID tracking systems, including appeals and disputes.
• Submit PMB motivation letters and clinical documentation packs.
• Handle PMB and COID claims through to payment and reconciliation.
• Liaise with medical scheme case managers, funders and stakeholders.
• Monitor PMB turnaround times and maintain rejection/appeal registers.
• Keep up-to-date with PMB regulations and Council for Medical Schemes guidance.
• Oversee COID/IOD claims cycle from presentation to final payment.
• Submit COIDA documentation and apply correct COID tariff coding.
• Track outstanding COID claims and coordinate with employers and providers.
• Reconcile COID payments with invoiced tariffs and follow up on short-payments.
• Maintain separate tracking for PMB appeals and COID, including dates and outstanding docs.
• Oversee billing and debt collection across medical aid, PMB, COID/IOD, RAF and private patients.
• Develop and monitor KPIs related to PMB/COID turnaround, rejections, and debtor days.
• Ensure accurate medical records and POPIA compliance.
• Manage EHR systems and ensure effective staff use.
• Handle patient complaints and maintain high patient service.
• Collaborate with hospitals, IT, suppliers and funders.
• Assist with marketing and professional networking.
• Ensure stock levels and maintain clinics, rooms and stock areas.
• Provide general admin and reception support when required.
• Capture and maintain patient employer and claim data.

Skills

PMB knowledge

COIDA/IOD claims

ICD-10 coding

Revenue-cycle management

Leadership

Policy compliance

Financial reporting

Stakeholder liaison

Process improvement

Staff training

Tools

Practice management software

Electronic health records

Job description

An established orthopaedic trauma and reconstructive surgery practice is seeking an experienced Practice Manager to oversee the day-to-day operations of a high-acuity specialist practice. The role carries significant responsibility for practice administration, team management, financial oversight and revenue-cycle management, with a particular focus on Prescribed Minimum Benefits (PMB) and Injury on Duty (IOD/COID) claims.

The successful candidate will be responsible for ensuring accurate, timely and compliant processing of PMB submissions and appeals, as well as managing high-volume COID claims through to payment and reconciliation.

Roles and Responsibilities (but not limited to):

• Oversee the day-to-day operations of the practice, ensuring efficient patient flow and service delivery.
• Lead, manage, mentor and support administrative and billing staff.
• Ensure adherence to practice policies, procedures, ethical standards and healthcare regulations.
• Manage staff leave and promote accountability and continuous improvement.
• Train and upskill billing and administrative staff on trauma ICD-10 coding, PMB regulations and COIDA requirements.
• Identify PMB-qualifying trauma diagnoses and ensure appropriate ICD-10 and CPT/NRPL/RPL coding.
• Prepare and submit PMB motivation letters and clinical documentation packs.
• Manage PMB appeals and disputes from submission through to resolution.
• Liaise with medical scheme case managers, hospital case managers, funders and relevant stakeholders regarding PMB cases.
• Monitor PMB turnaround times and maintain rejection and appeal registers.
• Keep up to date with relevant PMB regulations, scheme protocols and Council for Medical Schemes guidance.
• Manage the full COID/IOD claims cycle from initial patient presentation through to final payment and reconciliation.
• Complete and submit relevant COIDA documentation, including W.Cl.2, First Medical Reports, Progress Medical Reports and Final Medical Reports.
• Apply correct COID tariff coding for consultations, procedures and theatre services.
• Track outstanding COID claims and proactively follow up on unpaid or queried claims.
• Manage rejected or incomplete claims and coordinate with employers, HR departments and occupational health providers to resolve outstanding information.
• Reconcile COID payments against invoiced tariffs and follow up on short-payments.
• Maintain separate tracking systems for PMB appeals and COID claims, including submission dates, outstanding documentation and days outstanding.
• Oversee billing and debt collection across medical aid, PMB, COID/IOD, Road Accident Fund where applicable, and private/cash patients.
• Manage budgets, financial reporting, expenses and month-end reconciliation processes.
• Develop and monitor KPIs relating to PMB and COID turnaround times, rejections, outstanding claims and debtor days.
• Ensure accurate maintenance of medical records and compliance with POPIA requirements.
• Oversee practice management and electronic health record systems and ensure effective use by staff.
• Manage patient complaints and support a high standard of patient service.
• Liaise with hospitals, IT specialists, suppliers, contractors, funders and other relevant service providers.
• Assist with marketing initiatives and professional networking.
• Ensure the practice environment, examination rooms and stock areas are maintained appropriately.
• Assist with reception, patient scheduling, hospital admissions and general administration when required.
• Answer calls, manage messages and ensure patient enquiries are followed up appropriately.
• Capture and maintain accurate patient information, including employer and claim details for trauma and IOD patients.
• Manage patient accounts, payments, receipts, allocations, banking and petty cash.
• Assist with debt collection administration and follow-up of outstanding patient accounts.
• Ensure stock levels are maintained and place orders for medical and office supplies.
• Provide clinical and general practice support as required and directed.
• Assume the duties of other administrative staff when required to ensure continuity of practice operations.

Qualification and Requirements:

• Previous experience in a private specialist medical practice, preferably within orthopaedic, trauma or surgical environments.
• Proven Practice Management or senior medical administration experience.
• Working knowledge of Prescribed Minimum Benefits (PMB), including motivation and appeal processes.
• Practical experience with COIDA / Injury on Duty (IOD) claims, including statutory documentation and claim follow-up.
• Experience dealing with the Compensation Fund, compensation fund administrators or mutual associations advantageous.
• Sound understanding of ICD-10 coding and medical aid billing and authorisation processes.
• Knowledge of medical aid billing, PMB and COID tariff structures.
• Experience managing high-volume claims and administrative workloads.
• Strong financial and debtor-management experience.
• Experience with practice management software and electronic health record systems.
• Knowledge of POPIA and healthcare compliance requirements.
• Proven experience managing and training staff.
• Ability to manage PMB and COID tracking systems and maintain accurate records.
• Strong understanding of medical practice administration and revenue-cycle processes.

Skills & Attributes:

• Strong leadership and people-management skills.
• Excellent organisational and time-management abilities.
• Highly accurate and detail-oriented.
• Strong financial and analytical skills.
• Excellent communication and interpersonal skills.
• Strong problem-solving and follow-up abilities.Ability to manage high volumes without compromising accuracy or turnaround times.
• Ability to work independently and take ownership of responsibilities.
• Professional, ethical and accountable.
• Calm and effective under pressure.
• Strong patient-service orientation.
• Ability to prioritise competing demands and meet deadlines.
• High level of confidentiality and discretion.
• Proactive approach to identifying and improving operational processes.
• Strong computer and administrative skills.
• Ability to work collaboratively while maintaining professional boundaries.

Work Hours:

Monday to Friday, 08h00 17h00 (with occasional overtime as the practice demands)

Start date:

ASAP