Acting ofertas em África do Sul

The purpose of the Claims Assistant is to ensure the effective collection of outstanding accounts while fostering positive relationships with colleagues, patients, and funders. This role plays a key part in resolving account queries and addressing claim rejections efficiently.

• Assist with preparing and submitting claims to medical aids, insurance providers, and third-party funders.
• Ensure accurate billing codes (ICD-10, CPT, etc.) are used for GP and dental procedures.

2. Reviewing Day Sheets

Medical Aid Patients :

• Ensure claims are submitted with the correct service date, practice name, and treating doctor or therapist.
• Identify and correct any inaccurately submitted claims.
• Verify that all medical aid claims from the previous day were successfully processed.

Private Patients :

• Ensure claims are submitted with the correct service date, practice name, and treating doctor or therapist.
• Identify and correct any inaccurately claims.
• Verify that all private patient payments were allocated if not verify the payment method with the Front Desk staff. If the patient did not make a payment contact the patient and inform then that their account is outstanding followed by a statement via email.
• Add necessary Elixir notes on payment arrangements made with the patient accommodated with a follow-up date.
• All rejected claims must be resolved on the same day to prevent payment delays. If immediate resolution is not possible, the claim must be formally queried with the medical aid to avoid it aging beyond 30 days.

3. Day End Reporting :

• Generate the Day-End report from Elixir for the previous day to verify which patients were billed and confirm billing accuracy.
• Submit daily reports detailing findings, discrepancies, and any potential issues identified.

Main Purpose of Reviewing Day Sheets :

• To accurately review the previous day's day sheets and ensure all medical aid claims have been correctly submitted and successfully processed, enabling timely payments, minimizing delays or rejections, and supporting accurate reporting.

4. Daily Cash Up Sheet

• Verify that all patients who paid in cash are accurately recorded on the daily cash-up sheet.
• Ensure that the cash denominations are balanced and correctly accounted for.

5. Petty Cash

• Verify that all transactions are accurately recorded on the petty cash sheet.
• Ensure that the cash denominations are balanced and correctly accounted for.

6. Payment Allocations / Medical aid Remittances

• Allocate medical aid payments upon receipt of remittance advice or where applicable
• Verify EFT payments against proof of payment before processing allocations.
• Confirm cash and card payments with the Front Desk prior to allocation.

7. Age Analysis / Collection of outstanding accounts

• Review the age analysis report on a weekly basis to identify overdue accounts by Age Category (Current, 30, 60, 90 &120+ days)
• Focus on accounts in the 60- and 90-day brackets to prevent them from becoming uncollectible. Escalate accounts nearing 120 days for urgent action.
• Investigate and resolve queries, cross-check each overdue account for any outstanding queries, follow-ups or rejections. Address and resolve any issues that may delay payment.
• Contact Medical Aids and Patients - Follow up with medical aids for unpaid claims and patients for any shortfalls or co-payments. Ensure clear documentation of all communications.
• Update Notes and Payment Plans - Maintain updated notes on each account's status, actions taken, and expected payment dates. Where applicable, arrange and monitor patient payment plans.
• Escalate Unresponsive Accounts - Refer accounts that remain unpaid despite follow-ups further action (handover or write-off consideration).
• Share tips, solutions, and best practices to support team learning and future reference.
• Collaborate with colleagues to solve challenges, promoting a positive team environment and continuous improvement.
• Provide training and support to team members where knowledge or skill gaps are identified.
• Work closely with the reception team, practice manager, and clinicians to ensure accurate billing and follow-up.
• Attend weekly finance / admin meetings to report on claim progress, collections, and challenges.

Requirements

1. SOFT SKILLS

Attention to Detail

Ensures claims are accurate, payments are allocated correctly, and errors are caught early.

Communication Skills

Clearly communicates with patients, colleagues, and medical aids (verbally and via email).

Explains account balances, payment arrangements, and claim rejections in a patient-friendly manner.

Problem-Solving & Initiative

Proactively investigates rejected or overdue claims and takes ownership of resolving them.

Seeks solutions independently while knowing when to escalate.

Deals with sensitive financial discussions with patients calmly and respectfully.

Balances daily responsibilities (claims, collections, allocations) to meet deadlines (e.g., same-day rejection resolution).

Works closely with finance, reception, and clinical staff to ensure accurate data sharing and mutual accountability.

Accountability & Integrity

Handles cash, payments, and sensitive information responsibly and ethica

2. TECHNICAL / HARD SKILLS

Medical Billing Knowledge

Familiarity with ICD-10 and CPT codes, especially for dental and general practice procedures.

Knowledge of billing protocols for medical aids and private patients.

Claims and Rejection Resolution

Experience working with medical aid portals, Elixir (or similar systems), and remittance advices.

Understanding of medical aid rules and the appeals process.

Age Analysis & Collections

Experience reading and acting on an Age Analysis report.

Understanding of how to set up and monitor payment plans.

Payment Allocation & Recon

Confident with allocating EFT, card, and cash payments, including verifying petty cash and daily cash-ups.

Strong working knowledge of Elixir Live or other medical billing systems.

Good Excel or spreadsheet knowledge for reports and reconciliations.

3. SPECIFIC QUALIFICATIONS

Minimum Requirements :

• Matric Certificate (Grade 12)
• Basic understanding of medical billing and account collections
• 1–2 years experience in a medical admin, billing, or accounts receivable role

Preferred Qualifications :

• Certificate in Medical Billing & Coding (or similar)
• Finance / Bookkeeping Certificate or Diploma
• Elixir Live Training or system-specific training
• CPD or short courses in Customer Service in Healthcare , Debt Collection Practices , or Medical Claims Management

Company Benefits

As part of your employment package, you will receive the following benefits :

• Statutory Benefits in line with South African Labour Law, including :
• Family Responsibility Leave
• Unemployment Insurance Fund (UIF) contributions
• Compensation for Occupational Injuries and Diseases (COIDA) coverage
• Contribution Towards Medical Aid :

The company contributes towards your medical aid as part of your Total Cost to Company (CTC) . Employees are encouraged to join a registered medical aid scheme to benefit from this contribution.

• Professional Growth Support :

Opportunities for on-the-job training and support in developing skills related to medical billing, collections, and administration.

A collaborative, team-oriented culture that values respect, integrity, and continuous improvement.