Tariff Specialist

2 months ago

Cape Town, South Africa Health Solutions Full time

**Introduction**
- Momentum Health Solutions, an entity of Momentum Metropolitan Holdings 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.**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose**
- To manage the accuracy and quality of data in the Provider Tariff Master Files. The incumbent works in close collaboration with the Tariff Modelling and Rate Negotiation function and is responsible for the accuracy and efficiency of tariff file loads and for the maintenance of data quality across tariff files. The incumbent will also work with the Claims Management and Provider Management teams to resolve any tariff discrepancies and to ensure the integrity of claims adjudication processes.**Requirements**:

- 4-5 years' experience in the Medical Administration and/or Managed Care Industry.
- Sound knowledge of clinical coding structures especially tariff schemes.
- Understanding of medical scheme legislation including Council for Medical Schemes and Board of Healthcare Funders functions.
- Proficiency with Microsoft Office Suite with advance to intermediate skills in Excel
- Experience with the Oracle, Isquared and HiP operating system advantageous
- Tertiary qualification in medical field an advantage.

**Duties & Responsibilities**
- Work with the tariff modelling and clinical teams to analyse the impact of new tariff proposals.
- Work with the provider reimbursement negotiation team to analyse the impact of tariffs and rates over the
year.
- Work with the provider reimbursement negotiation team in annual tariff negotiation processes.
- Work with the provider reimbursement negotiation team to prepare tariff files for loading, with the IT Teams in file loads and for checking the accuracy of the tariff file load against rate agreements.
- Work with provider engagement team to prepare tariff related communications.
- Manage all discrepancies in loaded tariffs and resolution of related tariff file queries.
- Work with business and IT Teams to specify system requirements related to reimbursement models.
- Prepare and maintain operational documents and reports that relate to tariff file management.
- Identify opportunities to enhance cost effectiveness and increase operational efficiency.
- Positively influence and participate in change initiatives.
- Participate and contribute to a culture which builds rewarding relationships and provides exceptional
service.
- Continuously develop own expertise in terms of professional and industry and legislation knowledge.
- Manage financial and other company resources under your control with due respect.
- Act as ambassadors for the company in all external interactions.
- Take ownership for driving career development.

**Competencies**
- Technical mindset.
- Knowledge of clinical coding -; ICD-10, CPT-4, RPL Tariffs, NAPPI etc.
- Understanding of tariff structures and claims management processes.
- Able to work under pressure, meet deadlines and drive for results.
- Solutions orientated.
- Self-awareness.
- Diversity and inclusiveness.

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