Subject Matter Expert Sunninghill

Universal Health; Sandton; On-site; ZAR 300,000 - 450,000; Full time

Job summary

Universal Healthcare Group is seeking a Pathology SME to assess diagnostic pathology consultations and claims from service providers within a medical aid environment. You will assist in managing and supervising daily pathology service activities and ensure alignment with scheme rules.

Responsibilities include ongoing education on pathology queries, provider consultations to monitor claims, overseeing operations, and compiling reports as required.

Qualifications

• Matric/ Grade 12 required.
• 3–5 years’ experience in a similar role (Billing and Claims experience).

Responsibilities

• Continuous education relating to Pathology related queries and diagnostic evaluation.
• Consultation with the relevant providers and or stakeholders to ensure control and monitoring of claims related to Pathology results to ensure that they are in line with medical scheme rules.
• Oversee overall operation and administration requirements.
• Compile the relevant reports as required.

Skills

Billing and Claims

Education

Matric/ Grade 12

Job description

Universal Healthcare Group seeks a Pathology SME

Universal Healthcare Group seeks a Pathology SME to assess the diagnostic pathology consultations and claims from service providers. Assist in the management and supervision of the daily activities of the pathology services in a medical aid environment.

Duties & Responsibilities

1. Continuous education relating to Pathology related queries and diagnostic evaluation.
2. Consultation with the relevant providers and or stakeholders to ensure control and monitoring of claims related to Pathology results to ensure that they are in line with medical scheme rules.
3. Oversee overall operation and administration requirements.
4. Compile the relevant reports as required.

Desired Experience & Qualification

1. Matric/ Grade 12
2. 3-5 years’ experience in a similar role (Billing and Claims experience)