Medical Credit Controller (Richmond, Kzn), Pietermaritzburg

RESPONSIBILITIES Billing&Claims Administration

Capture, verify, and maintain accurate patient billing information, including medical aid details, authorisations, ICD-10 and tariff codes.

Prepare, submit, and track claims to medical schemes, administrators, and third-party funders in accordance with scheme rules.

Ensure claims are submitted timeously and accurately using the approved practice management system (e.g. GoodX).

Investigate, correct, and resubmit rejected or short-paid claims.

Manage pre-authorisations, extensions of stay, and benefit exhaustion in collaboration with case management.

Credit Control&Debtors Management

Monitor and manage debtors’ age analysis for medical aids, patients, and third-party payers.

Follow up outstanding claims and unpaid accounts within scheme-specific turnaround times.

Manage patient co-payments, member-liability accounts, and private-pay balances.

Issue statements and liaise with patients and medical schemes regarding outstanding balances.

Escalate long-outstanding or high-risk accounts to management.

Reconciliations&Financial Controls

Reconcile remittance advices against submitted claims and billing records.

Identify and report under-payments, over-payments, and unpaid claims.

Maintain accurate billing, payment, and adjustment records.

Assist with monthly billing reports, collections summaries, and audit support.

Compliance&Governance

Ensure billing and claims processes comply with HPCSA, BHF, PCNS, and medical scheme requirements.

Maintain strict patient confidentiality and comply with POPIA regulations.

Support internal controls, audits, and medical scheme queries.

Keep up to date with medical scheme rule changes and tariff updates.

Stakeholder&Team Liaison

Work closely with case managers, clinicians, reception, and finance teams to ensure accurate and complete billing.

Communicate professionally with patients regarding billing and account queries.

Liaise with switching companies, scheme administrators, and funders to resolve claims issues.

REQUIREMENTS

Grade 12 (Accounting or Maths advantageous)

Minimum 2–5 years’ experience in medical billing, claims administration, and credit control

Experience in a private hospital, mental health facility, or medical practice

Working knowledge of ICD-10 coding, medical aid authorisations, and scheme rules

Experience using medical billing systems (GoodX experience advantageous)

Strong attention to detail, organisational, and follow-up skills.

Preference will be given to candidates with prior experience in a hospital or inpatient healthcare environment.

RUMUNERATION R15,000 To 18,000 Per Month

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