Job Description

Closing Date 2024/06/21
Reference Number MMH240613-2
Job Title Manager: Masterfiles
Position Type Permanent
Role Family Client Services
Cluster Health Solutions
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Western Cape
Location - Town / City Cape Town
IntroductionMomentum Health, an entity of Momentum Metropolitan Holdings Limited, delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
Role PurposeThe role is responsible for the management of all price files in the Business System Solution area including the management of:

• Scheme, Modifier and Network rates
• Maintenance of network providers
• Maintenance of relative value units (RVU)
• Maintenance of rand conversion factors (RCF)
• Escalated tariff related queries
• Reporting on tariff discipline related queries
• Maintenance of Provider Masterfile
• Claims reprocessing

Requirements

• Matric
• Minimum of 3 - 5 years' experience in the claims operations environment is essential
• In depth understanding of reference price lists and industry standard pricing structure is essential
• Business or management degree or studying towards will be advantageous
• A clinical qualification or extensive clinical knowledge will be advantageous
• High level of proficiency in Healthcare and Medical Scheme administration landscape

Duties & ResponsibilitiesOperational Management

• Managing the day-to-day operational functions by ensuring Momentum Health Solutions meets and exceeds SLAs.
• Provide insights into what is driving transactional trends and provide innovative solutions to improving unnecessary volumes into Momentum Health Solutions environment.
• Actively pursue improvement in quality of back-office function processing.
• Oversee enquiry investigations and ensure that responses are comprehensive and well-constructed.
• Participate in regular operational and other forums as required by clients (All Momentum Health Solutions clients).
• Creating a positive working environment and optimise human capital outputs and quality.
• Management of Leave, overtime and productivity for team.
• Performance Management of team.
• Report on monthly / quarterly performance for the area under review as required by Scheme / Internal Stakeholders.
• Manage departmental budgets and employer asset base (hardware, software etc.)
• Ensure functional compliance with the Medical Scheme's Act.

Audit Function

• Ensure that functional area perfects audit findings and where these occur facilitate remediation within timelines agreed with internal/external auditors.

Stakeholder Management

• Drive collaboration with internal stakeholders to ensure optimal value chain service delivery.
• Develop sound relationships with customer in order to foster trust and credibility.
• Attend industry platforms to ensure MH visibility.
• Ensure compliance with internal and external requirements.

Competencies

• Business Acumen
• Client / Stakeholder Commitment
• Drive for Results
• Leads Change and Innovation
• Motivating and Inspiring Team
• Strategic Thinking
• Collaboration
• Impact and Influence
• Self-Awareness and Insight
• Diversity and Inclusiveness
• Growing Talent

PolicyWe are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Momentum Metropolitan