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

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

Only candidates who meet all the minimum requirements stipulated in the advert, will be considered. If you do not hear from us within two weeks of your application, please consider your application as unsuccessful.