BOC Johannesburg South - Billing Operations Cluster BOC Billings Manager

We provide meaningful careers that connect people with purpose.

We are united by a common purpose of providing the best and safest care; and by our shared values of Care, Truth, Participation, Compassion and Dignity.

Netcare invites you to be part of our journey.

ROLE SUMMARY

The incumbent oversees the daily operational processes at the Billing Operations Cluster. This includes ensuring that all billing activities, including PIP, DNYB, rejection management and special project streams are performed accurately and efficiently, meeting all deadlines and quality standards. Leads, motivates, and supports a team of billing- and case management professionals. This includes developing and implementing training programs, providing performance feedback and resolving problems. Manages data and metrics to track performance and identify areas for improvement. This includes developing and implementing reports, identifying trends and making recommendations for improvement. Partners with cross-functional teams to improve tools and systems. This includes working with IT, finance, and other departments to ensure that the billing process is efficient and effective.

KEY WORK OUTPUT AND ACCOUNTABILITIES

DISRUPTIVE INNOVATION

Billing Management tasks

• Ensuring daily, weekly, and monthly tasks as per Billing Manager level of task document.
• Monitoring and maintenance of the DNYB.
• Maintain set targets as indicated on the BOC Balanced Score Card.
• Monitoring and managing of Incomplete Case Management (ICM) Report.
• Partner with regional clinical coders to improve the outliers identified by the clinical coding quality trending dashboard.
• Analysis of billing errors with appropriate action plans.
• Monitoring and reporting on MHC variance.
• Management of Alternative Reimbursement Models and associated reporting.
• Ensuring SOPs are implemented and adhered to.
• Ensure effective usage of Bill of Service, Billing Estimation tool and Billing mapping.
• Management of DNYB, PIP, Rejections and E-queries/Debt pack.
• Identify and resolve audit findings and billing errors to ensure that billing practices comply with applicable funder rules and the Netcare Tariff Billing Guidelines.

General Tasks

• Assist with any other duties assigned by the BOC Manager from time to time.

Patient Liaison

• Advises on effective patient liaison and dispute resolution. This includes working with patients and their representatives to resolve billing issues.
• Liaise with Hospital Billing Co-ordinators for information flow.

Governance and quality management

• Identify quality improvement opportunities and ensure appropriate quality improvement initiatives are implemented and outcomes measured.

TRANSFORMATION OF OUR SOCIETY

Transformation target achievement

• Drive the achievement of transformation goals as set out by the Transformation Committee.

Build and maintain stakeholder relationships

• Work effectively and co-operatively with others to establish and maintain good working relationships that are mutually beneficial.
• Create and maintain a positive environment within the billings cluster where the differences of others are recognized, understood, and valued, so that all can reach their full potential and maximize their contributions.

Change Management

• Be a change management ambassador.
• Implement changes timeously and effectively.
• Promote and facilitate the use of digital tools to minimize the use of manual processes.

People management

• Overall management of the case management and billings staff and their performance.
• Create an environment where staff are aware of the role they play in the provision of quality care and their value to Netcare.
• Monitor staff attendance and/or absenteeism and ensure action is taken accordingly.
• Orientation of new staff member to the billings cluster.
• Development of talented leaders and high performers.
• Supervision of NiCCAMs.

Personal and professional development

• Keeping abreast of changes that affect the local business environment.
• Keep up to date with funder rules and requirements.
• Be acquainted with the developments in the managed health care industry.

SKILLS PROFILE

EDUCATION

Required

• B Degree/Diploma Nursing qualification or equivalent NQF level 6.

Preferred

• Qualified Registered Nurse

WORK EXPERIENCE

Required

• >3 years’ experience in a managed health care environment.

KNOWLEDGE

Required

• Advanced Computer Literacy
• Sound knowledge of Private Hospital billing operations, including Billings and Tariff guidelines

PHYSICAL REQUIREMENTS

• In the event of any physical or psychological limitation that may impair the employee’s ability to perform the required job function, the employee must consult the employer for reasonable accommodation.

SKILLS

Coaching Others

• The capacity to recognise development areas in others and support them to facilitate personal development through coaching.

Leading and Managing Change

• The capacity to implement and support change initiatives and to provide leadership in times of uncertainty.

Performance Development

• The ability to evaluate and develop different levels of capacity within a team to achieve set objectives.

Taking Action

• Capable of recognising the need for action, considering possible risks and taking responsibility for results.

Decision Making

• Capable of making decisions timeously and taking responsibility for the consequences.

Managing Self

• Capacity to plan, organise and control own work environment by setting appropriate priorities and achieving set objectives within a given time frame.

Customer Focus and Service Delivery

• The capacity to identify and respond to the needs of internal and external customers.

Adapting and Responding to Change

• Capable of supporting and advocating change initiatives and managing own reaction to change.

Continuous Improvement

• The capacity to improve systems and processes to facilitate continuous improvement.

Technical Knowledge

• The capacity to perform a technical function to required standards.

WORKING CONDITIONS

• Professional flexibility in working hours while supporting daily business operations.
• Will interact with internal and external customers through several different means.
• Travel to support the functions of the role may be required.

NETCARE VALUES AND BEHAVIOURS

Netcare Values
At Netcare, our core value is care. We care about the dignity of our patients and all members of the Netcare family. We care about the participation of our people and our partners in everything we do. We care about truth in all our actions. We are passionate about quality care and professional excellence.

• At Netcare, our core value is care.
• We care about the dignity of our patients and all members of the Netcare family.
• We care about the participation of our people and our healthcare partners in everything that we do.
• We care about the truth in all our actions.
• We listen with empathy and respond with acts of compassion in all interactions with our patients and their families.

The Netcare Way

Netcare is committed to providing quality care. Our basic service standard holds us accountable for the below seven behaviours which you will be accountable to uphold:

• Respect - I always greet everyone to show my respect.
• Identity - I always wear my name badge to show my identity.
• Dignity - I always treat others with consideration and humility to uphold dignity
• Care - I always act in the best interest of Netcare and others to show I care
• Compassion - I always listen with empathy and respond with kind action to show my compassion
• Appreciation - I always say thank you to show my appreciation.
• Diversity- I always embrace diversity to strengthen inclusivity and belonging.

Join the team committed to providing the best and safest health and care.